HX641 35349 
RC311.1  .Un3  The  agricultural  and 


RECAP 


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Columbia  SkitJem'ti) 

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BULLETIN  REEDUCATION 

No.  32  Scries  No.  f, 


The 

Agricultural  and  Industrial 

Community  for  Arrested 

Cases  of  Tuberculosis  and 

Their  Families 

V 

A  STUDY 


JUNE 
1919 


Issued  by  the 

FEDERAL  BOARD  FOR  VOCATIONAL  EDUCATION 

WASHINGTON 

WASHINGTON  [GOVERNMENT  PaiHTINQ  OFFICE  :  MM 


FEDERAL  BOARD  FOR  VOCATIONAL  EDUCATION. 


MEMBERS. 


David  F.  IIoistox,  CJiairmon, 

Secretary  of  Afjriculture. 
William  C.  Ricdfield, 

Secretary  of  Commerce. 
William  B.  Wilson, 

Secretary  of  Labor. 
P.  P.  Claxton, 

Commissioner  of  Education. 


Jamks  p.  Mwnuok,  Vi^-e  Cli<iir)iian, 
Manufacture  and  Coiiimcrce. 

Calvin  F.  McIntosh, 
Agriculture. 

Abthl-r  E.  Holdkr, 
Labor. 


EXECUTIVE  STAFF. 

C.  A.  Pnossun?,  Director. 
Layton  S.  Uawkins,  Chief  Vocational  Educational  Division. 
Chmilks  H.  Winslow,  Chief  Research  Division. 
H.  L.  Smith,  Chief  Rehabilitation  Division. 
L.  H.  Carris,  Assistant  Chief  Vocational  Edncation  Diinsion. 
W.  G.  Hummel,  Agricnltnral  Education. 
F.  G.  Nichols,  Commercial  Education. 
Anna  E.  Richardson,  Home  Economics  Education. 
J.  C.  Wright,  Trade  and  Industrial  Education. 

(2) 


FOREWORD. 


At  the  very  outset  of  its  work  with  the  (lis(;liai-^(Ml  clisiil>led  solfliers 
afflicted  with  tubcrcidosis  the  Federal  Board  Tecognized  that  the 
problem  of  reeducation  and  placement  in  employment  of  these  men 
is  one  that  requires  the  best  expert  advice  and  assistance,  which  tlie 
country  affords.  In  order  to  provide  this  the  National  Tuberculosis 
Association  was  requested  to  detail  to  the  office  of  the  Federal  Board 
its  field  secretary,  Dr.  H.  A.  Pattison,  who  has  been  giving  his  entire 
attention  to  this  phase  of  the  work  of  the  Board  under  the  vocational 
rehabilitation  act. 

To  direct  and  assist  in  the  discharge  of  this  responsibility  an  advi- 
sory committee  of  persons  of  long  experience  and  national  reputa- 
tion in  the  field  of  tuberculosis  was  appointed,  all  of  whose  members 
have  given  of  their  services  with  enthusiasm.  The  members  of  this 
advisory  committee  appointed  by  the  National  Tuberculosis  Asso- 
ciation are:  Fred  M.  Stein,  chairman;  W.  H.  Baldwin,  Dr.  H.  M. 
Biggs,  Dr.  Vincent  Y.  Bowditch,  Col.  George  E.  Bushnell,  Dr. 
Charles  J.  Hatfield,  Dr.  A.  J.  Lanza,  Dr.  David  R.  Lyman,  Dr. 
James  A.  Miller,  Mr.  Douglas  McMurtrie,  and  Dr.  George  M.  Price. 

Any  study  of  the  problems  relating  to  the  campaign  against  tuber- 
culosis inevitably  leads  to  a  consideration  of  the  colony  as  a  possible, 
and  perhaps  necessary,  part  of  the  campaign.  The  study  as  presented 
here  was  made  under  the  direction  of  the  Advisory  Committee  to  the 
Federal  Board,  which  committee  passed  the  following  resolution : 

That  it  is  the  sense  of  the  Advisory  Committee  that  the  plan  for 
an  industrial  conmiunity  for  tuberculous  people  who  are  able  to  work 
is  replete  with  interest  and  deserves  further  study.  It  is  recom- 
mended that  the  plan  be  published  and  that  discussion  be  invited 
from  all  agencies  interested  in  the  subject. 

Criticisms,  opinions,  or  suggestions  will  be  veiy  much  appreciated 
and  should  be  sent  to  the  National  Tuberculosis  Association,  381 
Fourth  Avenue,  New  York  City,  or  to  the  Federal  Board  for  Voca- 
tional Education,  Washington,  D.  C. 

C.  A.  Peosser,  Director. 
(3) 


THE  AGRICULTURAL  AND  INDUSTRIAL  COMMUNITY  FOR  ARRESTED  CASES 
OF  TUBERCULOSIS  AND  THEIR  FAMILIES. 

i'.y  J  I.  A.  J'Ai-iJ.soN,  M.  I). 

[lasiiod  under  direction  of  tho  Advisory  Committee  of  tlio  National  Tu^)orcuIofjl8  Ahso- 
cialion  as  a  contribution  to  the  study  of  liiobloma  relating  to  the  reiiahilltation  of  the 
tuberculous.] 

Within  the  past  10  years  a  number  of  investigations  have  been 
made  of  the  conditions — physical,  industrial,  and  social — of  patients 
Vidio  have  undergone  treatment  for  tiil)crculosis  in  sanatoria.  The 
end  in  view  has  been  tO'  secure  first-hand,  accurate  knowledge  of  their 
physical  condition  within  a  certain  number  of  years  after  discharge 
as  compared  with  their  condition  on  discharge,  their  living  condi- 
tions, their  earning  power,  employment  and  its  conditions,  the  ex- 
pectations of  health  and  life  after  discharge,  the  general  value  of 
sanatorium  treatment,  and  tlie  uncovering  of  weaknesses  in  pres:ent 
methods.     (See  Appendix.) 

The  evidence  is  overwhelming  that  the  campaign  against  tubercu- 
losis has  not  yet  developed  adequate  plans  and  facilities  for  the  post- 
sanatorimn  treatment  of  j^atients.  It  is  being  more  and  more  clearly 
established  that  it  is  the  environment  of  the  sanatorium  graduate 
and  his  method  of  spending  his  time  after  working  hours  that  most 
frequently  determine  his  fat©  rather  than  the  work  itself,  ^^^lile  in 
the  sanatorium  it  is  comparatively  easy  to  follow  the  prescribed 
regimen.  All  patients  are  doing  the  same  things.  Even  the  physi- 
cians, nurses,  and  other  employees  conform  to  many  of  the  rules  laid 
down  for  the  guidance  of  the  patients.  Often  the  nurses,  physicians, 
and  employees  have  themselves  had  active  tuberculosis,  and  there  is, 
therefore,  a  sympathetic  understanding  between  the  two  groups. 
But  when  the  patient  returns  to  his  home  he  is  a  man  apart  if  he 
continues  to  live  as  he  lived  in  the  institution.  Unless  his  family  is 
an  exceptional  one  the  family  life  will  not  be  adapted  to  the  man ;  he 
must  adapt  himself  to  the  life  of  his  family.  He  wants  to  partici- 
pate in  the  activities  his  friends  enjoy.  It  may  be  "movies,"  card 
parties,  dances,  picnics,  tramping  trips,  bowling,  baseball,  or  what 
not,  but  nearly  all  involve  the  element  of  contest,  and  the  recently 
arrested  case  of  tuberculosis  can  not  safely  compete  with  his  sound 
companions.  The  almost  inevitable  result  is  reactivation  of  the 
disease. 

If  he  could  work  and  mingle  with  men  in  like  condition  when  he 
leaves  the  sanatorium  his  chances  for  permanent  arrest  would  be 

(5) 


greatly  iucrcased.  The  months  and  sometimes  the  years  required 
to  bring  about  permanent  arrest  must  be  oaivfully  guarded.  The 
■work,  the  rest,  the  phiy,  the  whole  daily  round  nuist  be  so  arranged 
as  to  contribute  to  the  establislunent  of  a  s-ound  health.  The  value 
of  commingling  of  quic.sccnt  rases  is  demonstrated  at  Saranac  Lake 
where  so  many  have  remained  and  entered  the  commercial  and  ci\'ic 
life  of  the  village.  Tuberculous  men  and  women  who  have  lived 
comfortably,  prosperousl}',  and  happily  for  from  1  to  25  years  are 
found  there.  Tlie  doctor,  nurse,  architect,  tity  engineer,  public 
stenographer,  i>hotographer,  jeweler,  liveryman,  ehauil'eur,  waitress, 
tailor,  clerk,  and  merchanl.  have  worked  out  their  physical  and 
economic  salvation,  iluch  the  same  thing  is  observed  at  Colorado 
Springs,  Albuqner<iue,  and  Phoenix. 

!Many  men  and  "women  arc  able  to  resume  their  former  occupations 
if  their  surroundings  are  hygienically  favorable.  The  particular 
position  or  job  which  was  hold  is  often  the  cause  of  breakdown,  and 
not  the  occupation  as  such.  Some  can  regain  their  health  only  l)y 
finding  entirely  new  vocations.  Practically  all,  however,  require 
part-time  work  under  medical  and  nursing  supervision  in  a  well- 
chosen  environment  until  they  are  hardened  up  to  do  a  full  day's 
work  every  day.  There  is  at  present  little  provision  for  such  "  in- 
dustrial convalescence."  The  sanatoria  themselves  offer  a  few  open- 
ings for  their  ex-patients,  but  these  provide  for  a  very  small  per- 
centage. The  garment  shop  of  the  Committee  for  the  Care  of  the 
Jewish  Tubercidous  is  consj^icuous  alike  for  its  success  and  its  lone- 
liness in  the  field.  Similar  shops  should  be  established  in  other 
large  cities. 

But  there  would  still  remain  a  group  that  needed  different  treat- 
ment. If  tuberculosis  is,  as  some  one  has  put  it,  "  a  disease  of  wages," 
it  is  also  a  disease  of  congested  areas.  There  can  be  no  question  that 
many  thousands  of  tubercidous  people  and  their  families  would  be 
vastly  better  off  in  suitable  rural  regions.  Their  children,  almost 
always  infected,  would  have  a  better  chance  to  halt  successfully  the 
growth  of  implanted  germs.  , 

For  years  past  the  literature  of  tuberculosis  has  contained  refer- 
ences to  the  need  of  some  sort  of  "colony"  in  which  sanatorium 
graduates  might  find  the  environment  needed  to  restore  the  fullest 
measure  of  liealth.  At  first  the  references  indicated  a  vague  groping 
for  a  solution  of  problems  not  fully  comprehended.  The  earliest 
thought  was  of  the  agricultural  colony,  but  it  was  soon  realized  that 
the  farm  alone  was  not  sufficient.  The  urban  dweller  has  little 
inclination  to  till  the  soil;  nor  is  it  easy  for  the  substandard  man  to 
learn  a  vocation  so  wholly  new  as  fanning.  Then,  too,  experienee 
has  proved  that  many  tuberculous  people  get  on  better  in  factories 
than  out  of  doors,  and  very  much  better  in  sedentary  clerical  posi- 


tions  than  in  factories.  This  of  course  in  not  hocausc  outdoor  life 
is  not  in  itself  more  desirable  and  more  bcnencial  than  indoor  life, 
but  because  most  outdoor  occupations  require  severe  physical  exer- 
tion, and  often  subjccjt  the  worlcer  to  undue  exposure  to  lieavy  rains, 
extremes  of  heat  and  cold,  strong  winds,  etc.  Hence  diversified 
occupations  must  be  available  and  the  trend  of  opinion  has  been 
directed  toward  the  coml)incd  indiistrinl  and  agricidtiiral  community. 

It  is  interesting-  to  follow  the  development  of  ideas.  I  sliall  refer 
only  briefly  in  the  text  of  this  bulletin,  however,  to  the  literature 
on  the  subject.  Those  who  are  particularly  interested  will  fmd  in 
the  appendix  extracts  from  reports,  magazines,  and  books. 

In  1908  Dr.  A.  M.  Forster  put  theory  into  practice  by  providing 
supervised  farm  work  at  Eudowood  for  selected  cases.  The  scheme 
has  been  continued  under  Dr.  M.  F.  Sloan  and  has  been  successful 
medically  and  economically.  The  work  has  consisted  in  hotbed 
planting,  transplanting,  gathering,  and  assorting  vegetables;  can- 
ning; poultry,  hog,  sheep,  and  rabbit  raising;  berrying  and  fruit 
culture ;  grain  raising,  silo  filling,  dairying,  and  repairing  buildings 
and  fences. 

It  seems  a  misnomer,  however,  to  call  this  development  a  "  colony," 
for  during  the  10  years  previous  to  1918  but  120  patients  had  re- 
ceived this  saipplementary  treatment.  It  is  rather  a  department  or 
adjunct  of  a  well-rounded  sanatorium  project,  and  an  example  which 
many  other  superintendents  and  trustees  might  well  emulate. 

At  the  sixth  annual  meeting  of  the  National  Tuberculosis  Asso- 
ciation Dr.  Forster,  discussing  aftercare,  remarked  that  "  in  conjunc- 
tion with  sanatoria  and  hospitals  there  should  be  developed  colonies 
where  cases  may,  to  a  large  extent,  continue  under  the  advantages  of 
institutional  care,  and  at  the  same  time  be  either  entirely  or  largely 
self-supporting."  During  the  same  discussion.  Dr.  H.  Holbrook 
Curtis  said : 

I  have  no  trouble  in  tliinklug  of  what  to  do  with  patients  who  are  to  be 
cured ;  but  I  find  that  there  is  no  provision  made  In  any  sanatorium  with  which 
I  am  connected,  or  ever  heard  of,  as  to  what  the  patient  should  do  for  liimself 
after  he  left.  It  is  my  opinion  that  farms  should  be  established  and  these 
farms  should  be  supported  by  the  State. 

Again,  at  the  eighth  annual  meeting  of  the  National  Tuberculosis 
Association,  Dr.  Forster,  discussing  a  paper,  remarlvs  that — 

Dr.  Vogeler,  in  one  of  his  conclusions,  says  that  the  farm  colony  idea  is  im- 
practicable. I  am  not  sure  by  what  subtle  means  of  deduction  he  has  reached 
that  conclusion.  I  do  not  believe  that  he  has  tried  the  farm  colony  or  that  he 
can  cite  any  case  Avhere  the  farm  colony  has  failed.  I  think  he  is  putting  the 
case  a  little  too  strongly.  At  Eudowood,  where  the  farm  colony  idea  lias  been 
A'cry  carefully  worked  out  and  put  into  practice,  I  believe  the  opinion  is  that 
during  the  six  years  of  its  existence  it  has  been  highly  sticcessfuL 

Another  of  Dr.  Yogeler's  objections  is  that  we  can  not  get  city  people  to  work 
in  the  country.    He  should  go  further  and  explain  just  why  you  can  not  get  city 


8 

pooplo  to  work  in  the  (ouiury.  Various  e(T<irts  it>  iiisiituto  a  iiuivoiuont  luit-k  to 
the  laiul  liave  I'aileil  lar^^oly  tlirouirh  hick  of  syiupatlu'tio  appreciation  of  the 
point  of  view  of  the  city  slum  tlwellc-r.  As  I  pointed  out  in  the  pai)er  to  wliicli 
Dr.  Voyeler  has  referred,  it  is  out  of  the  qiu'stion  to  loolc  for  success  where  you 
take  tlie  city  ilweller  into  tlie  country  and  tliere  leave  liini  unaided  to  work  out 
the  problems  «>f  his  new  environment. 

However  visionary  our  ideas  nuiy  be  as  to  the  merits  of  agriculture  as  a 
permanent  form  of  employment,  there  can  he  no  arjjument  as  to  the  value  of  the 
farm  colony  as  a  means  of  prolonging  the  term  of  treatment.  With  the  present 
cost  of  sanatorium  treatment  it  is  not  justifiable  to  keep  patients  in  idleness 
after  they  are  in  physical  condition  to  do  some  labor. 

At  the  first  annual  meeting  of  the  national  association.  Dr.  Herbert 
HuxonKing  had  thought  further  than  the  fann  colony  for  a  solution 
of  the  prolileni,  but  nieroh'  speculated  "on  the  results  "which  could  be 
obtained,  theoretically  at  least,  in  the  ideal  sanatorium  with  pro- 
vision for  industrial  features."^ 

Dr.  S.  Adolphus  Knoi)f  suggested,  in  1912, ''  intermediate  stations  " 
where  the  recovered  tuberculous  patient  could  find  work  with  which 
he  is  familiar.      (Api^endix.) 

Dr.  Charles  F.  Bolduan  at  the  tenth  annual  meeting  remarked : 

Industrial  colonies  in  the  country,  open-air  factories  in  the  cities,  cooperation 
with  those  providing  outdoor  employn)ent — all  have  carefully  to  be  considered, 
and  probably  all  will  have  to  be  utilized  to  meet  this  great  need. 

Discussing  Dr.  Bolduan's  paper.  Dr.  F.  H.  Heise,  of  Trudeau,  said : 

When  you  consider  that  the  tuberculous  patient,  and  especially  the  poor 
tuberculous  patient  with  a  family,  is  one  of  the  hardest  things  on  earth  to  keep 
isolated — that  is,  to  keep  away  from  his  family  and  friends — you  realize  that 
if  you  want  to  get  right  down  to  the  bottom  of  it  you  have  to  provide  for  the 
patient  and  make  some  provision  for  the  family  who  are  close  to  him.  Probably 
this  might  take  the  form  of  industrial  colonies  where  the  patient  could  main- 
tain himself  and  where  the  family  could  be  employed  to  help  maintain  them- 
selves. A  company  at  Saranac  Lake  at  the  present  time  has  awarded  a  prize 
of  .$500  for  s<mie  method  of  solving  such  a  problem;  that  is,  of  giving  employ- 
ment to  the  tul)erculous  patient  after  he  has  left  the  sanatorium,  to  make  him 
happy  and  comfortable,  and  give  him  a  chance  to  carry  out  the  treatment  that 
he  knows  he  needs  and  ought  to  take. 

The  "World  TVar  has  stimulated  interest  in  the  colony  idea  for  dis- 
abled soldiers  and  sailors,  particularly  in  England,  and  there  has 
appeared  a  rather  extensive  literature,  as  will  be  seen  by  reference  to 
the  appendix.  I  would  direct  attention,  however,  particularly  to  a 
statement  by  the  commissioner  of  immigration  at  the  port  of  New 
York,  who  says : 

All  of  the  warring  countries  are  emphasizing  the  necessity  of  returning  the 
soldiers  to  the  land.     In  England,  Australia,  and  Canada  the  farm  colony  is 

1  Such  an  institution,  let  us  say,  should  consist  of  three  main  divisions,  infirmary, 
pavilion,  and  industrial  doparlment,  the  first  two  forming  complete  units  each,  the  last 
divided  into  as  many  distinct  units  as  there  are  branches  of  industries  undertaken.  For 
instance,  agriculture  in  its  various  l)i-unclifs ;  stock -raisins',  includin}?  poultry  farming,  hoe 
culture,  etc.  ;  ciTtaln  manufacturing  industries,  and  the  administration  of  the  institution 
itself  in  its  various  phases.      (Dr.  II.  M.   King.) 


9 

being  (lovclopod.  I*l\perl«  liave  ,suI)iniU(;(l  Uiat  tlio  Koldicr  will  not.  t;il<t;  up  an 
unbroken  piece  of  land  iMolat(!d  from  iils  fellows.  Official  commissions  in  Kn^j- 
land  and  Australia  are  developing  plans  by  which  the  St:al:e  will  kcII  1o  the 
returning  sol<li<H'S  ready-rnad*;  fiirniK  of  lioni  .'*.  t,o  30  acres  which  one  inini  cim 
cultivate.  Fiirnis  are  grouix-d  iis  ii  <'oniiriun]l.y  with  cducationiil,  rcfi-f-ntional, 
and  cooperative  agencies  lor  marketing  and  buying.  Men  are  sold  funns  witli 
a  house,  barn,  and  sumci(>nl;  capital  on  onsy  terms,  tlur  State  (idvancjng  nine- 
tenths  of  tlie  capital  to  be  repaid  on  long-term  installments.  'J'lie  oxiterience  of 
Australia  and  of  Denmark  dem(mstratos  the  success  of  this  jdari.  In  the  Unified 
States  such  colonies  should  be  located  iu  New  Kngland,  the  Southern,  Central, 
and  Western  States,  eacli  adjusted  to  a  special  kind  of  farming. 

Attention  is  also  directed  to  the  opinion  of  P.  C.  Varrier-Joncs, 
who  has  made  the  Papworth  Hall  Colony  for  the  Tuberculous  a 

success : 

What  is  the  remedy?  What  but  to  graft  on  to  our  existing  sanatoria  the 
colony  principle  of  employing  patients  at  their  own  or  allied  trades. 

There  is  not  the  slightest  doubt  that  soldiers  will  stay  in  a  village  com- 
munity, always  provided  that  the  amenities  of  life  ai"e  there.  Social  surround- 
ings, healthy  environment,  steady,  and  not  too  laborious  work,  freedom  of  con- 
science, home  life  remodeled  on  sound,  healthy  lines,  all  these  things  should  be 
within  their  reach. 

The  scheme  is  an  ambitious  one,  but  this  is  the  day  of  gi'eat  enterprises.  We 
hear  a  good  deal  about  the  establishment  of  village  communities  for  disabled 
men.  For  no  class  of  the  disabled  is  a  life  sheltered,  and  yet  active,  protected 
and  yet  self-respecting,  so  necessary  as  for  the  tuberculous.  The  man  who  has 
suffered  the  loss  of  a  limb,  or  the  loss  of  sight,  may  still  ilnd  a  place  in  his  old 
surroundings,  if  properly  assisted  and  trained;  the  man  suffering  from  shell 
shock  may  need  long  convalescent  treatment  away  from  the  stress  of  town  life, 
but  eventually  he  will  probably  be  able  to  resume  his  old  occupation ;  the  con- 
sumptive, alone,  if  seriously  attacked  by  disease,  can  never  hope  for  even  a 
modicum  of  health  and  strength  in  crowded  streets  and  ordinary  workshops ; 
the  consumptive  alone,  of  all  this  sad  procession  of  broken  lives,  can  never 
return  to  normal  conditions  without  endangering  his  family  and  his  fellow- 
workmen,  without  involving  not  only  himself  but  others  in  disaster. 

Let  communities  be  started  iu  which  our  consumptive  soldier  can  live  in  Ms 
own  home,  shielded  from  the  fierce  competition  of  the  outside  world,  a  self- 
respecting  worker,  an  economic  asset.  Let  employment  be  found,  the  model 
fnctory  erected,  the  hours  of  toil  properly  regulated,  a  fair  wage  paid.  In  such 
villages  his  children  can  be  carefully  protected  from  infection  by  open-air 
schools  supervised  by  a  competent  health-visiting  staff.  The  man's  leisure 
hours  can  be  made  glad  by  recreation  arranged  by  the  colonists'  own  committee, 
and  his  life  agreeably  spent.  "A  mere  Utopian  dream,"  they  say,  "  and  how  do 
you  knoM'  that  the  consumptive  ex-soldier  will  submit  even  to  such  conditions?" 
I  say  that  he  has  already  done  so,  that  requests  for  admission  to  the  Papworth 
Colony  now  far  exceed  the  accommodation.  "  In  that  case,"  the  critic  answers, 
"  the  demand  will  always  be  greater  than  you  can  possibly  meet."  The  demand 
is  great.  Is  that  a  reason  why  we  should  not  try  to  meet  it?  We  sincerely 
want  to  do  well  by  these  men;  shall  we  stop  at  wanting,  and  put  forward  no 
practical  solution?  "But  the  expense  will  be  ruinous!"  So  is  the  evil;  so  too 
the  cost  of  the  eviL 

If  one  village  community  of  this  kind  can  be  slioicn  to  carry  icithin  it  the 
germ  of  success,  the  idea  will  surely  fructify  and  similar  communities  iQill 
118663°— 19 2 


10 

spnH*;  up  lOU-ttd  ccH^tinff  »o*uiti>ria  (»•  in  other  suitable  spots.  A.  large  wuntry 
l^uus4.>,  suiToiuwlod  by  gtiriit'iis  aiul  gmssliiuiLs,  as  at  I'apworrh,  form.s  em  oxofl- 
leut  nucleus,  and  sm-h  houses  ofu«i  <'oino  into  the  market  la  these  days  of 
fhuuyo.  The  viUufe'e  c-nn  to  a  hir^'e  extent  be  built  by  the  colonists  themselves. 
They  iK'j^iu  l>y  buildini?  shelter.s,  ihey  may  go  on  to  buiUling  cottages — sijecially 
tlesigntnl  slieltera  and  cottages;  and  then  to  makii»g  the  furni(ur>>  for  thase 
slielters  uiul  cottages.  The  joy  <>f  so«'hjg  \iseful  and  beautiful  things  gnnving 
untler  thv4r  liands,  the  developnuiit  of  uiusvle  and  vitality  which  cohk's  wiLh 
work  carritHl  out  without  fatigue,  ihe  clieerful  surroundings,  the  senst'  of  com- 
radeship; and,  best  of  all,  tin"  prosix'ct  of  a  return  to  a  happy  family  life,  are 
most  powerful  aids  to  nature  in  driving  out  the  ravager,  where  tliis  is  still 
possibh>,  or  in  limiting  his  ravages  when  he  is  too  securely  entrenched  to  l>i> 
dislodged. 

Examination  of  the  literature  will  indicate  that  no  one  ha.s  pre- 
senteil  any  ver^'  concrete  plan  or  program  for  a  complete  village  Avith 
the  exception  of  one  man  in  this  country  and  one  in  P^.ngland.  The 
former  is  Dr.  Bayard  T.  Crane,  president  of  the  Kiithiiid  Private 
Sanatorium  Association.  This  association  is  composed  of  doctors, 
nurses,  and  majiagtrs  of  eight  private  sanatoria  and  boarding  houses 
in  Jutland,  Mass.  Tt  is  not  a  stock  company,  hut  is  incori>orated  under 
the  laws  of  Massachusetts  as  a  charitable  and  bene\olent  associatioji, 
not  for  profit.  It  is  under  the  jurisdiction  of  the  State  board  of  Chari- 
ties and  is  supported  by  voluntary  contributions. 

The  association  owns  00  acres  of  arable  and  wooded  land  upoa 
"which  are  a  farmhouse,  barn,  and  some  stock,  dairy,  and  farm  impl(^- 
ments.  A  rcsddontial.  recreation,  and  workshop  building,  00  by  85 
feet,  has  been  built  and  partially  equipped.  On  the  first  floor  there 
is  an  office  and  gift  shop;  a  large  recreation  room  with  an  adjoining 
workroom  which  may  l)e  combined  into  an  auditorium  seating  al)()Ut 
200  people,  and  there  is  also  a  large  glassed-in  porcli.  The  basement 
contains  the  heating  plant,  storage  room,  and  carpenter  shop,  and  also 
a  pottery  glazing  equipment.  The  third  floor  has  a  complete  house- 
keeping arrangement  with  living  quarters  for  eight  men.  There  are 
separate  apartments  for  the  matron  and  cook.  There  is  also  a  library 
with  500  volumes.  Effort  is  made  to  ]irovide  for  remunerative  occu- 
pation either  for  aiTested  cases  or  members  of  their  families.  The 
matron's  husband,  for  example,  is  a  patient,  and  another  patient's 
daughter  acts  as  secretary  and  stenographer.  !Men  who  reside  in  this 
buihling  are  all  ar)'ested  cases  and  receive  remuneration  for  the  work 
they  do,  and  all  nonresident  patients  who  are  able  to  work  more  than 
10  hours  a  week  are  paid. 

At  present  the  work  done  in  this  building  is  chiefl)'  occupational 
therapy — weaving,  ba.sketrj',  pottery,  etc.    An  autobus  owned  by  the 

Note. — "  Tt  is  kinder  to  the  returned  tuberculous  s<ildier  and  better  for  the 
cnmmunity  that  whenever  po.ssihlc  he  shoiild  be  given  i'very  facility  to  earn  his 
living  and  taught  a  trade  if  rifce.ssary.  Tiu^  vilhiirc  coinniuiiity  sy.'^tem  appeals 
to  present  several  advantages  for  this  purpose."  ( From  an  editorial  in  the 
Journal  of  the  American  Medical  Association,  Feb.  8,  1919.) 


11 

association  brings  from  the  various  sanatoria  in  tlio  town  lliose 
patients  that  arc  able  to  take  this  form  of  therapy. 

Last  snnnrn^r  alxmt  40  ao'os  wci'c  inuler  cnltivati<Hj,  and  a  con- 
sideral)le  anioiuit  of  the  work  was  done  by  tlie  patients. 

No  direct  charges  arc  nisuhi  to  the  patients  for  the  benefits  of  this 
plan.  The  privilege  is  <ij)en  to  about  90  nonresident  patients  in  the 
town.  Some  bedside  instruction  is  also  given  in  the  corLstitueut 
sanatoria. 

On  contiguous  property  a  sanatorium  for  125  patients  is  under 
construction  by  the  Central  New  England  Sanatorium  (Inc.),  also 
a  corporation  not  for  ]:)rofit.  This  sanatorium  is  equipped  tf>  main- 
tain a  sanatorium  essentially  for  middle-class  or  wagtveai'iiing  men 
and  women  of  limited  means  who  will  pay  a  certain  part  of  the  per 
capita  cost.  It  is  planii.ed  to  provide  under  model  conditions  physical 
and  medical  care  of  a  particularly  fine  character. 

The  Crane  plan,  however,  does  not,  I  apprehend,  contemplate  a 
complete  and  distinct  community  unit.  The  colony  is  in  and  a  part  of 
the  village  of  Rutland. 

The  celebrated  British  landscape  architect  and  planner  of  estates 
and  cities,  Thomas  H.  Mawson,  has  presented  a  plan  for  "  Industrial 
villages  for  partially  disabled  soldiers  and  sailoi^  "  in  a  book  en- 
titled "An  Imperial  Obligation."     (See  appendix.) 

Industrial  communities  have  developed  rapidly  in  this  country. 
Many  of  them  have  grown  about  a  single  industry  for  the  sake  of  that 
industry,  such  as  a  steel  mill,  coal  or  mineral  mine,  etc.  The  converse 
proposition  is  the  one  I  wish  to  offer — the  develoyrrhent  of  industries 
around  a  GOTnmunity  for  the  sake  of  thai'  community^  whidi  is  to  be 
made  up  chiefly  of  arrested  cases  of  tuberculosis  among  soldiers,  sail- 
ors, and  civilians.  Those  soldiers  and  sailors  who  are  substandard 
physically  because  of  other  forms  of  disability  than  tuberculosis 
would  not  be  debarred,  but  the  totally  disabled  epileptic  or  mentally 
deranged  could  not  be  received.  There  would  also  Ije  perfectly  well 
people  occupying  executive  positions  or  placed  in  jobs  such  as  were 
required  to  keep  processes  going. 

This  piX)position  is  an  ambitious  scheme  which  one  might  well 
approach  with  trepidation,  but  I  have  nevertheless  addressed  myself 
to  the  absorbing  task  of  suggesting  the  main  features  of  a  plan. 

The  community  should  be  complete  within  itself,  yet  of  course, 
and  necessarily,  in  immediate  touch  with  other  neighboring  villages 
and  cities. 

Topographically  it  should  be  well  situated  upon  elevated,  hilly 
ground  with  several  acres  of  woodland,  and,  if  possible,  with  an 
active  but  small  river  winding  through  it.  The  tract  should  be 
located  within  100  or  200  miles  of  some  large  city  and  not  in  an  iso- 
lated corner  of  a  far- western  State.     Pioneering  has  been  fatal  to 


12 

some  colony  projects  uiul  ulinost  certainly  woiikl  be  disastrous  to  this 
one.  It  should  be  upon  a  line  of  railroad  and  preferably  a  main  line, 
with  ready  accossibility  to  raw  materials  and  markets. 

The  villa<;e  proper  should  be  laid  out  acoordin*^  to  modern  ideas 
of  town  planning  to  care  for  live  or  six  liiindrcd  p()i)ulation  almost 
immediately.  Avilli  possibilities  for  expansion  to  4,000.  Its  <x<*'^f'i'!d 
features,  in  my  opinion,  should  conform  to  those  of  other  Amcrii-an 
towns,  rather  than  to  English  garden  cities.  "^Miile  the  homes  should 
be  diverse  in  design,  the  architectural  tout  ensemble  should  be  harmo- 
nious and  artistic.  In  this  it  would  ditVcr  decidedly  from  the  ordi- 
nary American  communities  which  lune  grown  without  phin  or  fore- 
Ihought.  It  would  differ  likewise,  in  that  its  water  sui)ply  and 
sewerage  system  would  bo  modern  and  complete  from  the  standpoint 
of  sanitary  engineering. 

The  department  of  health  should  be  model  in  every  respect  and  be 
given  a  j^lace  of  honor  coecjual  in  importance  with  the  industrial 
phases  of  the  community.  Conservation  and  restoration  of  man 
jjower  would  be  given  first  consideration. 

There  would  be  <liagnostic,  j)athological,  and  research  laboratories. 
The  director  of  the  department  would  be  given  as  many  medical 
assistants  and  public  health  nurses  as  the  growth  of  the  community 
required.  Every  person  (man,  Avoman,  or  child)  who  came  to  take 
up  residence  would  be  given  a  complete  physical  examination,  in- 
cluding steroscopic  chest  plates  and  biologic  tests.  Periodic  reex- 
eminations  and  special  examinations  when  indicated  by  the  appear- 
ance of  symptoms  would  preserve  a  life  history  of  the  "  human  ma- 
chine," making  it  possible  to  reduce  greatly  the  morbidity  and  mor- 
tality rates  in  comi^arison  with  other  industrial  towns  of  like  size. 

Under  such  conditions  an  unusual  opportunity  would  be  ofl'ered 
for  the  development  and  application  of  psychological,  trade,  effi- 
ciency, and  fatigue  tests. 

The  population  would  be  drawn  largely  from  the  sanatoria  of 
neighboring  states.  If  located  near  New  York  City,  for  example, 
there  are  about  140  sanatoria  in  New  York,  New  Jersey,  Pennsyl- 
vania, and  Maryland  from  which  to  draw  cases.  There  were  be- 
tween liO.OOO  and  25.000  admissions  to  these  sanatoria  in  1917,  and 
presumably  about  an  equal  number  of  discharges.  There  are  also 
many  tuberculous  people  in  our  cities  who  for  one  reason  or  another 
can  not  be  given  sanatorium  tieatment,  yet  who  could  avail  them- 
selves of  the  opportunities  offered  in  a  colony  for  part-time  employ- 
ment under  medical  supervision.  Several  sanatorium  superinten- 
dents with  whom  the  colony  idea  has  been  discussed  are  strongly 
of  the  opinion  that  there  would  be  a  constant  waiting  list  of  those 
wanting  residence. 


13 

Wliilc  the  populiitioji  must  Ijc  drawn  from  many  sanaU^ria  and 
dispensaries,  a  sanatorium  should  be  built  in  or  near  the  village. 
The  community  sanatorinni  woidd  l)e  phmrKMl  to  ('m})ody  the  licst 
ideas  in  construction  and  management.  There  is  now  under 
way  a  movement  to  classify  sanatoria  according  to  certain 
standards  of  cni(;icncy.  Tl)is  new  sanaloi-ium  Avonld  he  plannerl 
to  represent  tlie  liigliest  ])rcsent-day  standards,  which  means  that 
it  would  not  be  "monumental"  in  character,  but  one  of  simplicity, 
comfort,  and  utility.  If  more  than  one  institution  were  needed,  dif- 
ferent types  of  construction  could  be  shown.  Ultimately  there 
would  be  a  small  general  hospital  with  a  wing  or  department  for 
infectious  and  contagious  diseases. 

Miss  J.  S.  Whitney  and  Mr.  Philip  P.  Jacobs,  of  the  National  Tu- 
berculosis Association,  and  others  suggest  that  since  this  community 
is  for  arrested  cases  of  tuberculosis  and  is  to  be  a  health  town  there 
should  be  no  sanatorium,  but  rather,  a  general  hospital.  Those  cases 
that  developed  symptoms  of  reactivation  would  be  given  treatment  in 
their  own  homes  or  emergency  treatment  in  a  special  ward  of  the 
hospital  imtil  the  flare-up  subsided.  This  is  an  excellent  suggestion 
worthy  of  carefid.  consideration.  For  the  full  rounding  out  of  the 
educational  features  of  the  community,  however,  a  sanatorium  would, 
in  my  opinion,  be  an  ultimate  if  not  immediate  necessity. 

Schools  of  the  open-air  type  would  be  an  important  demonstration 
feature.  One  of  the  aims  would  be  the  training  o£  aiTested  cases  of 
tuberculosis  to  take  positions  as  teachers  in  open-air  schools  of  other 
cities. 

Special  training  courses  would  prepare  men  and  women  to  give 
occupational  therapy  and  prevocational  training  in  sanatoria,  thus 
sending  forth  missionaries  to  prepare  sanatorium  patients  for  the 
colony.  The  results  obtained  by  the  Reconstruction  Division  of  the 
Army  with  occupational  therapj^  make  it  safe  to  prophesy  that  simi- 
lar measures  will  be  more  rapidly  adopted  in  civilian  sanatoria  than 
heretofore.  Male  instructors  are  needed  now  and  there  are  few  to  be 
found.  Sanatorium  graduates  may  be  trained  in  our  village  for  this 
work. 

Another  educational  feature  would  be  special  postgraduate  courses 
for  physicians  similar  to  the  Trudeau  School.  There  would  also  be 
special  courses  for  lay  workers  in  the  antituberculosis  campaign. 
The  tuberculosis  institutes  of  the  National  Tuberculosis  Association 
might  well  hold  half  of  each  course  in  such  a  community. 

Of  prime  importance  to  the  success  of  the  project  are  its  industries, 
for,  after  all,  man  must  live,  if  not  by  the  sweat  of  his  brow,  at  least 
by  "  insensible  perspiration."  Experience  has  proved  that  arrested 
cases  of  tuberculosis  can  "  carry  on  "  in  industries  of  lighter  character 


14 

if  the  environment  and  Uio  regimen  are  proper.  One  lias  onlj'  (o 
fiflanco  ihrongh  (lie  Kcgjister  of  American  Manufacturers  to  realize 
the  poasibilities.  Those  sex^nred  would  depend  npon  the  location 
of  the  connnunity  and  the  "leads"  discovered  and  followed  up 
l»y  tlK>  director  of  industries.  Undoubtedly  the  trustees  would  have 
to  develop  one  or  more  shops.  Manufacturers,  however,  would  be 
^iven  inducements  tx)  embark  in  business  in  the  village.  Ijct  it  be 
clearly  understood  that  a  dominant  industry  must  be  assured  before 
phiii^ring  iuto  town  dcNelopment.  Snbsidiary  enterprises  will  not  be 
diilicidt  to  iind. 

One  specific  possibility  shoidd  be  mentioned,  and  that  is  a  printing 
establishment  built  for  or  by  the  National  Tuberculosis  Association, 
which  itself  contracts  for  tens  of  thousands  of  dollars'  worth  ol' 
printing  annually.  Other  printing  contracts  could  be  secured  from 
iieighboring  St^ite  associations  and  from  sanatoria. 

Once  industries  are  started  that  give  emj^loyment  to  100  or  more 
people  a  conununity  of  some  sort  is  assured.  Other  contributoiy 
occupations  at  once  become  a  certainty.  Houses  must  be  built  for 
the  families  of  workers,  streets  laid  out,  and  sidewalks  made.  Stores 
jnust  be  developed  along  with  ail  the  other  various  and  sundry  actixi- 
ties  that  go  to  make  up  a  village,  a  town,  or  a  city.  Consider  the 
possibilities  of  employment  outside  the  factories  as  the  community 
grows. 

Physicians.  ^  Butdiers.  Hotel  employees. 

A  surgeon.  Druj^.^ists,  Maids. 

Kurses.  Stationers.  Coolcs. 

Tiiachers.  .Tewders.  ChaulTours. 

A  lawyer  or  two.  Photo-^rraphers.  Station  apents. 

Bank   clerks.  Clerks.  Telegraphers. 

A  Protestant  clergj'man.  Plumbers.  Telephone  operators. 

A  Catholic  clergj-nian.  l*ainters.  Common  laboror.s. 

Hardware  merclianls  Enj^ineers. 

Grocors.  r>arhers. 

"We  have  not  touched  upon  the  agricultursil  possibilities.  The  first 
thought  of  the  general  practitioner,  and,  until  recently,  of  some 
tuberculosis  experts  has  been  "light  outdoor  work"  related  to  agri- 
culture, horticulture,  or  animal  husbandry.  Theoretically  the  idea 
is  sound,  hut  heretofore  has  not  been  practicable  for  the  majority  of 
cases,  l)ecause  they  are  tradesmen,  professional  or  industrial  workers 
untrained  in  farming.  That  lack  of  training,  as  well  as  insufficient 
capital,  makes  it  impossible  for  them  to  go  into  business  themselves. 
To  Avork  for  others  means  long  hours,  hard  work,  and  poor  pay. 

My  conception  of  a  farm  colony  that  has  any  chance  of  success  is 
one  in  which  colonists  are  grouped  upon  a  large  farm  tract,  which 
has  been  subdivided  into  smaller  tracts,  ranging  in  extent  from  2  or  3 
to  30  or  40  acres,  all  under  the  management  of  a  farm  expert. 


15 

Euc;li  man  W()ul<l  IjC/  iraiiicd  to  specialize  alorij^  ccrl/aiii  liucis  and 
1)0  ])ai(l  !i  noiiiiiial  wage  witli  subsistence  wliilc  leaj-ning  general 
fartniii<.i^.  T!io]t(\  would  bo  general  crop  pnxbjcl.ion,  glass  and  truck 
gardening,  dairying,  hog  and  poultry  i-aising,  beekeeping,  and 
Jinrsory  and  greenhouse  development. 

The  i:)r()duce  would  supply  the  village  and  any  surplus  W(njld  be 
shipped  to  outside  markets.  The  farm  hands  would  also  be  fc^tiders 
to  tlie  village  commercial  life.  As  patients  becan)e  proficient  and 
physically  capable,  they  would  b(5  encouraged  to  rent  or  purchase 
farms  within  a  few  miles  of  the  village  where  they  would  he  entirely 
independent,  but  within  reach  of  counsel  when  needed. 

John  Molitor  in  Housing  in  Relation  to  Health  and  Morals,  writes : 

Wliatevei'  we  are  trying  to  accomplisli  or  to  do  for  the  benefit  of  the  people 
leads  us  by  one  path  or  another  to  tUo  bousing  problem.  The  place  in  which 
man  or  woman  dwells  is  vital  to  the  character  of  health  and  of  all  that  follows 
from  bad  Iicalth.  We  find  that  depressed  vitality  is  a  most  fruitful  cause  of 
social  evil ;  bad  housing  is  one  of  the  direct  causes  of  depressed  vitality. 

Cleanliness  is  not  only  a  condition  of  health  but  of  self-resi;)ect.  Cleanliness, 
healtli,  morals,  self-respect,  and  manners  are  all  Immensely  depressed  by  bad 
housing,  and  are  correspondingly  raised  when  the  environment  is  improved. 

Not  alone  in  the  congested  areas  of  our  great  cities  are  there  to  be 
found  bad  bousing  conditions.  The  writer  d.uring  a  j)ractice  in  a 
small  community  has  had  to  drive  chickens  from  the  accouchment 
room,  unprotected  by  a  screen  door.  Every  country  doctor  is  familiar 
with  the  all  too  common  practice  of  farmers'  wives  who  fill  the  sasli 
crevices  of  bedroom  windows  with  cotton  or  paper  to  keep  out  the 
winter's  cold. 

The  Dunn  County  (Wis.)  survey  indicated  a  higher  death  rate 
from  tuberculosis  in  10  rural  townships  than  the  city  of  Milwaukee 
and  several  lesser  cities  of  Wisconsin.  The  White  County  (111.) 
survey  discovered  an  amazing  incidence  of  tuberculosis. 

The  industrial  and  agricultural  community  would  make  possible  a 
demonstration  of  ideal  rural  housing  conditions.  All  cottages  would 
be  so  designed  as  to  permit  porch  sleeping  for  the  tuberculous  mem- 
ber and  at  least  open  bedroorn  sleeping  for  the  rest  of  the  family. 

We  are  confronted  with  the  question  as  to  how  the  inception  and 
growth  of  such  a  community  is  to  be  brought  about.  Should  it  be 
inaugurated  by  a  governmental  agency?  In  my  opinion,  no.  The 
scheme  as  suggested  here  must  be  planned  comprehensively  at  the 
very  beginning  and  progi*ess  continuously  under  essentially  the  same 
management.  Changing  political  administrations  would  probably 
mean  changes  in  the  governing  board  with  consequent  changes*  in  the 
general  policy,  which  would  result  ultimately  in  a  patchwork  town. 
This  is  not  infrequently  to  be  observed,  in  the  school  systems  of  our 
cities.    The  experiment  (let  us  frankly  tenn  it  an  experiment)  must 


16 

bo  vorv  flexiblo  aiul  it  is  certain  tluit  direct  <jovenimontal  control 
conld  not  bo  ehistic  enough  nnd  re,siK)nsivc>  e.nouij:h  to  the  new  condi- 
tions constantly  arising  which  woukl  confront  the  directore. 

A'isnalization  of  the.  origin  and  gi'owth  of  the  community  will  make 
it  apparent  that  the  ordinary  political  organization  of  our  American 
towns  would  tend  to  bo  destnictivo  of  the  main  objcctivo.  The  am- 
bitions and  vagaries  of  village  and  city  politicians  could  not  be  in- 
trusted with  internal  control,  at  least  until  the  community  has  been 
long  enough  in  existence  to  lun  e  developed  its  own  peculiar  charac- 
ter and  trailitions. 

It  is  suggested  by  a  legal  friend  ^  that — 

Tlie  keynote  of  the  entire  plan  should  be  "  social  cooperation."  Each  of  those 
tiTiiis  is  to  ln>  Considered  in  its  fullest  sense.  It  is  evident  that  unless  there  is 
such  an  altruistic  cooperation  between  (1)  the  individuals  who  are  to  be  bene- 
fited, and  (2)  the  nuinicipal  and  (3)  social  orfranization  of  the  villaj;e  or  city, 
and  (4)  the  employers  of  labor  in  the  community  the  experiment  is  bound  to 
result  in  failure.  For  instance,  in  the  matter  of  emitloyment  by  manufac- 
turers and  others  who  may  be  induced  to  use  the  services  of  the  arrested  cases 
it  will  not  do  to  assume  that  such  employers  will  be  altruistic  without  a  social 
compact  which  at  the  same  time  is  a  legal  contract  to  use  to  the  utmost  pos- 
sible limit  the  services  of  arrested  cases.  It  is  conceived  that  such  a  contract 
can  be  made  in  connection  with  the  leasing  of  ground  and  construction  of 
buildings,  if  employers  cf  labor  with  this  spirit  of  cooperation  can  be  secured. 

But  it  is  also  very  clear  that  such  general  cooperation  can  not  be  secured 
through  the  use  of  the  ordinary  village  or  city  form  of  government,  because  such 
a  municipality  can  not  legally  enter  into  and  enforce  the  necessary  contractual 
rights.  Involved  in  this  problem,  of  course,  is  the  absolutely  essential  matter  of 
each  employer  being  required  by  contract,  with  proper  forfeiture  clauses,  to 
furnish  constantly  to  the  arrested  cases  such  sanitary  working  conditions  speci- 
fied by  the  National  Tuberculosis  Association  as  most  advantageous  and  least 
liable  to  bring  on  the  recurrence  of  active  infection. 

The  only  way  to  have  complete  control  of  the  situation  until  it  is  ascertained 
that  the  whole  plan  will  not  be  defeated  by  the  sale  of  lands  and  the  organization 
of  municipal  control  under  the  laws  respecting  the  organization  and  conduct 
of  municipal  corporations  of  the  State  in  which  the  village  or  city  will  be 
located,  is  to  maintain  the  underlying  fee-simple  title  in  a  semipublic  organiza- 
tion which  will  take  the  burden  and  control  upon  itself.  At  the  outset  of  the 
experiment,  and  probably  for  a  long  time,  this  involves  a  surrender  to  the 
idea  of  "social  cooperation"  of  certain  of  the  civic  riglits  of  each  qualified 
voter  in  so  far  as  munieipal  affairs  are  concerned,  liut  it  is  submitted  that  one 
who  is  not  uilling  to  surrender  such  rights  in  order  to  aid  the  experiment  need 
not  ask  for  the  benefits  of  the  experiment.  There  will  be  no  compulsion  in 
respect  to  this  matter. 

It  will  be  said  that  the  idea  of  not  parting  with  the  title  to  the  land  is  a 
repetition  of  the  experiment  made  at  the  city  of  Pullman,  111.,  near  Chicago, 
but  it  is  conceived  that  a  very  radical  difference  can  be  accomplished  by  work- 
ing out  a  proper  legal  program;  such  a  program  in  tentative  form  might  be  as 
follows : 

((I)  The  control  of  the  manufacturers  and  other  employers  of  labor  is  of 
prime  importance,  and,  therefore,  the  trustees  who  assumed  the  burden  of  the 

>  Judge  John  A.  Street,  Los  Angeles,  Calif. 


17 

experiment  properly  could  lease  l;iri(.I,s  .s(;lected  by  Jiiunufiicturlii;,'  plants  for 
such  lonff  periods  of  time  inid  at  sncli  low  rciitalH  us  woiilrl  imliief  rii!iriufii<"f  iirers 
to  come  to  the  villuKO  and  construct  plants  of  tiie  cliaractcrr  wliidi  would  be 
advantageous.  f-luital)le  rencjwiil  terms  of  sucJi  leases  could  Im;  Included  in  the 
lease  and  suitable  clauses  inserted  to  enable  the  trustees  to  purcbase  the  plant 
at  fair  valuation  in  case  of  business  failure  or  otber  conditions  which  would 
make  it  desirable  to  do  so.  All  of  this  can  be  worked  out  on  a  practical  basis 
beyond  question.  The  proper  class  of  construction  and  agreements  respeetlng 
employment  of  arrested  cases  should  be  included  in  tlie  same  contract. 

(I))  It  is  conceived  that  similar  leases  to  individuals  who  will  build  homes 
and  stores,  warehouses,  etc.,  can  be  worked  out  so  tbat  the  interest  of  the 
individual  in  the  land,  as  far  as  a  transfer  to  another  person  is  coneern(Kl,  will 
have  practically  the  same  value  as  if  the  fee-simple  title  was  vested  In  the 
Individual  who  builds, 

(c)  The  question  of  building  and  maintaining  schools,  fire  stations,  a  build- 
ing to  serve  the  same  public  purposes  as  a  city  hall,  the  maintenance  of  public 
parks,  and  other  such  matters  as  are  connnonly  carried  on  by  a  city  govern- 
ment is  rather  complex.  It  is  suggested  that  a  clause  in  each  lease  providing  for 
an  equitable  annual  assessment  of  rent  against  each  parcel  to  cover  the  same 
purpose  as  taxation  might  be  worked  out  and  placed  in  each  contract  respecting 
land.  It  is  also  suggested  that  the  cost  of  paving  streets,  installing  sidewalks, 
curbing,  and  sewers,  installing  a  complete  lighting  system  for  public  and  private 
lighting,  and  a  gas  plant  for  fuel  could  all  be  worked  out  by  equitable  apportion- 
ment against  all  leaseholders  within  the  confines  of  the  village,  or  the  lighting, 
water,  and  gas  systems  could  be  capitalized  at  cost  and  each  private  user  pay 
monthly  bills  as  usual  in  ordinary  municipalities. 

The  foregoing  program  necessarily  requires  expert  advice  and  service,  which 
it  is  conceived  would  be  contributed  without  cost  by  leading  experts  in  all 
departments  in  view  of  the  fact  that,  as  far  as  the  trustees  are  concerned,  the 
whole  matter  would  not  be  organized  for  financial  benefit  but  for  service  to  the 
Nation. 

The  writer  suggests  that  the  necessary  funds  should  be  sought 
among  the  agencies  that  have  concerned  themselves  "with  the  needs 
of  war  and  reconstruction.  The  funds  appropriated  would  be 
placed  in  control  of  five  trustees,  men  of  large  affairs  and  broad 
vision  in  business  and  the  professions.  If  possible,  let  there  be  two 
Ijusiness  men,  one  medical  expert  in  tuberculosis,  a  lawyer,  and  an 
educator. 

The  trustees  shall  purchase  the  land,  secure  and  approve  plans, 
contract  for  buildings  and  public  works,  and  invest  fmids  mtrusted 
to  them.  They  shall  lay  down  a  fundamental  policy  for  the  guid- 
ance of  the  executive  staff,  which  would  be  organized  somewhat  as 
follows : 

Managing  director. 

Director  of  industry  and  public  works. 

Director  of  department  of  public  health. 

Director  of  department  of  education  and  publicity. 

Auditor  {citj  clerk). 
It  will  be  seen  that  these  five  are  somewhat  comparable  to  the  com- 
missioners in  the  commission-manager  form  of  government. 
118663°— 19 3 


18 


l'\)r  the  ordinary  village  ci>nmiuiuty  ihis  organization  would  l)o 
looked  upon  in  the  present  day  iis  somewhat  top-heavy  and  expensive. 
But  for  the  development  and  administration  of  the  type  of  village 
and  the  e.-qienditure  t)f  the  amoimt  of  money  involved  such  a  staff 
would  be  rciiuired.  There  would  be  immediate  need  also  for  other 
executive  oflicers,  such  as  the  head  farmer,  resident  physician  of  the 
f^anatoriuni,  etc.,  while  sooner  or  later  a  director  of  recreation  and 
city  engineer  would  pi'obahly  be  needed. 

The  following  is  a  list  of  properties  and  developments  that  may  be 
required.  Most  of  them  are  fundamental  necessities.  Some  of  them 
might  be  built  through  other  means  than  appropriation  by  the  spon- 
sors of  the  project.  Certain  l)uildings,  for  examj)le,  would  be  built 
bv  the  man  or  firm  or  corporation  that  would  occupy  them: 


Pumping  ami  power  i)lunt. 

Fiiv  house  and  tHiuipnient. 

Laundry  building  and  equipment. 

IloLel  (one  wing  of  ultimate  buildiufO. 

Hotel  oquipmont 

Garage. 

r'ac-L(iry  building. 

I'rinting  e.stablislniieut. 

Hail  road  sidings. 

Auto  trucks. 

Storage  wai-eliouse. 

Salaries,  wages,  legal  and  engineering 
fees,  traveling  expenses  during  de- 
velopment period,  7J  per  cent  of  csti- 
niiited  cost  of  development. 

Contingent  fund,  10  per  cent  of  total 
estimated  cost  of  development. 

has  been  outlined  two 


I^nd,  1,000  acres. 

Thirty  acres  of  immedbite  village  im- 
provements —  house  and  storm 
sewers,  water  pipes,  streets,  side- 
walks, electric  lighting,  planting,  etc. 

Oneliuudred  cottages  for  woi-kers. 

r'ifteeu  houses  for  town  and  sliop 
administration  officers. 

Temporary  office  buildings  during  con- 
struction. 

Office  equipment 

Farm  buildings  and  equipment. 

Foundation  stock,  cattle,  horses,  hogs, 
sheep,  poultrj'. 

Store  buildings. 

General  liospital  or  .sanatorium. 

School  building  (four  rooms). 

Tn  estimating  the  cost  of  such  a  project  a- 
imiin  factors  are  involved : 

First,  town  planning  and  development.  The  \  ill  age  would  be 
planned  to  care  for  a  population  of  3,500  to  4,000.  The  unmediate 
development  is  for  approximately  220  workers,  or  a  total  population 
of  550  to  600.  Costs  ha^'e  been  based  upon  estimates  given  by  ^ncn 
with  special  experience  in  particular  phases  of  the  problem — ^architects, 
consulting  engineer,  in-actical  farmer,  aud  dean  of  an  agricultural 
college,  etc.  The  initial  development  cost  under  present  conditions  is 
$1,643,098.  The  year-to-year  growth  would  depend  upon  the  number 
of  applicants  for  residence  and  the  indu.stries  that  could  be  secured  to 
supply  work  for  applicants. 

It  is  estimated  that  tlie  village  could  be  made  to  take  care  of  an 
increase  of  100  per  cent  in  populati(jn  by  the  exi)e!Kliture  of  from 
$600,000  to  $800,000,  thereby  very  materially  reducing  the  investment 
per  capita. 


19 

The  second  cost  factor  is  rriaintcr)ancc  expense.  It  is  didicult  to 
estimate  the  cost  ol"  adniinistei'iiig  a  j)hint  such  as  tliis.  The  li^uies 
I  am  able  to  gather  lead  me  to  believe  that  the  requii-ements  for  such 
an  orfi;anization  as  has  been  described,  includinf^  salaries  of  executive 
staff,  clerical  assistance,  school-teachers  and  supplies,  public  health 
nurse,  counsel  fees,  cost  of  lighting  and  cleaning  and  oiling  streets, 
garbage  and  ash  collection,  maintenance  of  fire  department,  -water 
department,  etc.,  would  be  nearly,  if  not  quite,  $00,000.  No  estimates 
can  be  offered  as  to  farm  expenses,  but  it  is  reasonable  to  expect  that 
within  a  year  or  two  the  farm  would  be  at  least  self-supporting. 

Rentals  from  houses,  dormitories,  stores,  garage,  and  laundry 
building,  fees  for  garbage  and  ash  collection,  charges  for  electric  cur- 
rent, etc.,  will  bring  a  return  of  not  less  than  $00,000  per  annum. 
After  deducting  insurance  premiums,  county  taxes,  and  repairs  there 
would  remain  a  substantial  balance  to  help  offset  administrative  ex- 
penses. As  the  town  grew,  the  expenses  would  not  increase  propor- 
tionately and  in  a  few  years  the  corporation  should  be  self-support- 
ing, though  return  on  the  investment  would  be  rather  too  much  to 
hope  for. 

During  the  first  months  of  residence  most  of  the  families  and 
single  persons  would  not  be  wholly  self-supporting ;  some  subsistence 
aid  must  be  contributed,  and  the  total  maximum  fund  which  it  is 
estimated  would  be  required  during  the  first  year  is  $56,050.  In  ar- 
riving at  this  figure,  as  in  determining  development  costs,  we  have 
sought  to  cover  maximum  needs.  The  method  of  investigation  and 
the  results  appear  in  the  appendix. 

Can  all  this  be  accomplished?  There  should  be  few  indeed  in 
this  year  of  1919  to  assert  tliat  it  can  not  be  done.  Was  it  not  Dis- 
raeli who  said,  "  The  impossible  will  be  accomplished  to-morrow  "  ? 
There  have  always  been  learned  (if  not  wise)  men  who  have  denied 
the  truth  of  scientific  discoveries  or  declared  some  proposed  new 
forward  step  to  be  impossible  of  achievement.  Scientists  "  proved  "■ 
the  impossibility  of  flying,  but  the  Wright  brothers  flew.  There  is 
a  large  group  of  Prussians  who  boldly  proclaimed  that  the  Americans 
wouldn't  fight,  couldn't  raise  an  slyuij  if  they  would  fight,  and 
couldn't  get  the  army  to  France,  even  if  they  could  raise  one.  They 
were  obliged  to  witness  the  accomplishment  of  this  "  mipossibility." 

Certain  insurance  companies  have  found  it  profitable  to  accept 
substandard  lives  as  insurance,  risks.  The  Committee  for  the  Care 
of  the  Jewish  Tuberculous  and  some  industrial  corporations  have 
found  it  profitable  to  make  use  of  substandard  lives  in  industry.  Is 
it  not  worth  while  to  invest  a  few  hundred  dollars  in  each  of  one 
thousand  or  more  substandard  lives  in  developing  a  demonstration 
of  a  model  town? 


20 


Thomas  Adams  sfivs:* 


One  of  the  chief  causes  of  past  inililTorence  to  bad  coiminmity  ilcvelopment 
has  been  the  erroneous  assumption  that  it  consists  of,  or  is  best  left  to  talce 
place  as,  a  "natural  p:ro\vth."  Surely  If  anything  is  artiticial  it  is  the  modern 
city  or  town.  If  anything  needs  the  application  of  science  and  of  sane,  expert, 
and  governinental  dire<tion  to  promote  healthy  and  to  prevent  unhealthy  forms 
of  development,  it  is  the  industrial  eoiunnmlty  of  the  present  day. 

We  have  not  failed  to  build  up  wholesome  industrial  communities;  we  have 
not  tried  to  build  them.  We  have  left  their  bulldiiig  t<>  proceed  not  only  with- 
out planning  or  direction,  but  with  encouragement  to  land  speculation  and 
wasteful  systems  of  land  development  and  with  protection  to  the  claimants  of 
artiticial  rights  in  property,  oven  when  the  lives  and  health  of  the  people  have 
been  injuroil  as  a  result. 

We  do  not  want  reform  of  our  system  of  land  and  housing  development;  we 
want  to  begin  to  employ  system.  AVe  do  not  want  to  endanger  legitimate 
Interests  in  property,  but  to  establish  them.  We  do  not  want  to  inaugurate 
socialistic  extremes,  but  to  forestall  them.  We  do  not  want  to  lessen  liberty, 
but  to  make  it  more  widespread.  And,  recognizing  that  life  is  more  important 
than  property,  that  the  aim  of  all  production  is  life  aud  not  money,  and  that 
real  national  wealth  is  to  be  measured  by  the  health  of  the  people,  we  Lave 
either  to  control  the  right  to  property  so  that  it  shall  not  endanger  the  right 
to  live  in  wholesome  surroundings  or  face  inevitable  decay. 

Dean  Georjre  W.  Kircliway,  Federal  director  of  the  United  Slates 
Employment  Bureau  for  the  State  of  New  York,  is  quoted  as  saying 
(New  York  Evening  Sun,  Jan.  30,  1919)  : 

We  should  embark  upon  more  public  works  and  improvements  as  soon  as 
possible.  Surely  if  we  can  spend  billions  upon  billions  in  treasure  for  the  tak- 
ing of  human  lives  in  defense  of  our  country  in  war  time  we  can  afford  still 
better  the  expenditure  of  a  portion  of  those  vast  sums  in  the  undertakings  of 
peace,  which  will  benefit  commerce  and  industry  and.  still  better,  leave  a 
lasting  heritage  of  health  and  happiness  for  our  own  citizenry  and  the  genera- 
tions yet  to  come. 

AH  that  is  needed,  in  my  opinion,  is  stated  by  Mr.  Adams: 

The  things  that  are  demanded  of  public  loaders  to-day  are  courage,  rapid 
decision,  and  imagination,  rather  than  the  timid,  indecisive,  and  dilatory 
methods  of  the  legal  mind  that  control  our  policies  under  normal  conditions. 
We  have  to  take  risks  whether  we  will  or  not.  We  have  to  cease  raking  up 
ashes  of  precedents.  We  have  to  think  in  terms  of  big  ideas  as  well  as  big 
sums  of  money. 


1  nousc    and    Town    Development    In    War   Time.      By   Thomas    Adams,    town    planning 
ad%-iscr,  Canadian  commission  of  construction. 


ArrENDix  I. 


EXTRACTS  FROM  REPORTS,  PERIODICALS,  BOOKS,  ETC.,  IN  REF- 
ERENCE TO  COLONIES  FOR  THE  DISABLED. 

[From   Momorandum   to  Advisory   Committee  on  Tuljorculosis,   Feb.   0,   1010  :   The  e8tal> 
lislunent  of  productive  vocalioiuil  workKliops  for  t)JO  rcliabllitation  of  IuIktcuIouh.] 

In  3913  the  departmont  of  health  of  New  York  City  undertook  a  study  "  to 
secure  Jirst-hand  accurate  knowledge  in  regard  to  patients  within  five  years 
after  discharge  from  sanatoria ;  to  learn  their  present  physical  condition  as 
compared  with  that  on  discliarge ;  their  living  conditions ;  capacity  for  work 
and  earnings;  employm-ent  and  its  conditions;  expectations  as  to  health  and 
life  after  discharge  from  sanatoria,  etc.,  in  the  hope  that  such  knowledge  might 
perhaps  result  in  a  comprehensive  plan  for  tlie  more  cai'eful  and  coiuprehensive 
care  of  patients  on  discliarge,  to  the  end  that  whatever  good  had  been  accom- 
plished by  sanatorium  treatment  miglat  not  subsequently  be  lost  through  ignor- 
ance of  what  was  further  required." 

With  the  permission  and  cooperation  of  the  autliorities  in  charge,  tlie  names 
and  last  addresses  of  patients  discharged  from  the  municipal  sanatorium  at 
Otisville,  the  State  sanatorium  at  Ray  Brook,  and  tlie  Montefiore  Home  Country 
Sanatorium  at  Bedford  Hills  were  obtained  as  basic  records.  Altogether  the 
names  of  97S  patients  were  obtained  iu  this  way. 

Among  the  significant  findings  concerning  the  working  capacity  of  273  patients 
discharged  during  the  years  1005  to  1910,  inclusive,  it  was  learned  that  of  62 
cases  discliarged  as  cured,  but  4-1  were  working ;  of  75  discharged  as  arrested, 
53  \vere  working ;  of  89  classified  as  improved,  50  were  working ;  and  of  47  un- 
improved, 18  were  working. 

"  This  shows  very  strikingly  the  tremendous  liandicaiJ*  produced  by  tubercu- 
losis, for  we  see  that  even  of  the  patients  discharged  as  '  cured,'  the  large  pro- 
portion were  unable  to  work.  There  is  little  doubt  but  that  this  is  largely  in- 
fluenced by  the  patients'  enforced  return  to  the  crovrded  (and  for  him)  un- 
healthful  city.  Experience  at  Otisville  lias  shown  that  kept  in  the  country,  un- 
der conditions  similar  to  those  of  the  sanatorium,  a  large  proportion  of  tlie 
patients  continue  able  to  Avork." 

It  was  found  that  over  one-third  Avere  living  under  conditions  wliich  made 
continued  improvement  impossible.  They  were  found  in  dark  tenements,  many 
of  which  were  without  any  direct  connection  with  the  outer  air ;  many  rooms 
opened  upon  air  shafts  only ;  in  51  places  of  abode  chances  of  improvement  were 
further  lessened  by  neglect  and  dirt ;  12  per  cent  of  the  patients  slept  in  the 
same  bed  with  other  members  of  the  family. 

It  was  found  that  the  majority  of  sanatorium  patients  permanently  learned  dur- 
ing their  residence  the  principles  of  health,  and  as  far  as  their  means  permitted 
tliey  tried  to  carry  these  principles  into  their  daily  lives  at  home  and  at  work. 
Many  of  those  wlio  did  not  attributed  their  failure  to  do  so  to  high  rents,  high 
cost  of  living,  high  cost  of  food,  and  bad  factory  conditions. 

Undernourishment  was  apparent  among  many  families  coming  within  the 
scope  of  the  investigation. 

(21) 


22  • 

Further  svicial  contrnl  was  riH'oiniuemleil,  in  Ix'  tibtainod  by  iiiereasi'd  saiia- 
torhuu  facilities,  in'miittiii};  a  limuer  stay  in  tlie  institutiun ;  by  prKviciiiij? 
I'ettor  ailaiitability  to  occupation  and  trade;  l\v  the  trial  of  country  colonies  as 
a  pos.sil>le  lielp  In  tlie  solution  of  tb»>  problem  of  occupation  and  of  increased 
li-nvrtb  of  care  and  treatment  in  order  to  build  solidly  for  liealtlj;  by  a  con- 
tinued follow-up  service,  including  iusti'uctiou,  friendly  supervision,  and  periodic 
riH»xand  nation.     •     *     * 

A  similar  study  of  the  present  condition  of  l.liriO  patients  dlschnrged  fnuu  the 
Massafhiisetts  State  Sanatoria  from  May.  1!»12,  to  May,  1914,  was  made  in 
l)tH-eml)er,  15)10.     A  brief  sununary  shows  the  followiuR  facts: 

(1  )  Of  l.OHG  patients  discbar;red  from  the  Massachusetts  State  Sanatoria 
from  May,  1912,  to  May,  1914.  on  admission  17  per  cent  were  incipient,  3G  per 
cent  moderately  advanced,  and  46  per  cent  far  advanced. 

(2)  On  the  lir.st  visit  to  these  patients  in  their  homes,  in  each  case  within 
liiree  mouths  after  discharj^e  fi'om  a  sanatorium,  28  per  cent  were  in  good  con- 
diiion,  5(1  iH?r  cent  living.  11  per  cent  dead,  and  fl  per  cent  had  left  the  State 
or  disappeared. 

(3)  At  pre.sent  (meaning  by  this.  December,  1!)1G)  we  Ihid  that  29  per  cent 
are  in  good  condition  and  at  worii,  11  per  cent  living,  45  per  cent  dead,  and  13 
Iier  cent  disappeai'ed. 

(4)  Of  the  312  patients  now  in  good  condition  and  at  worli,  on  their  admis- 
sion to  a  sanatorium,  35  per  cent  were  incipient,  43  per  cent  moderately  advanced, 
and  22  per  cent  far  advanced. 

(5)  On  discliarge  these  312  patients  were  classified  as  58  per  cent  quiescent 
or  arrested  and  30  per  cent  as  improved. 

(6)  Comparing  tliose  patients  who  stayed  in  a  sanatorium  under  six  months 
with  those  who  stayed  longer  than  this  we  find,  as  would  be  expected,  lliat 
distinctly  better  results  were  obtained  among  those  patients  who-se  period  of 
stay  at  the  sanatoria  was  the  longer. 

The  report  contends  tliat  sanatoria  are  distinctly  worth  while,  but  some 
system  whereby  patients  can  be  looked  up,  visited,  and  advised  after  their 
discharge  is  an  essential  part  of  sjinatorium  treatment.  No  .suggestions  relative 
to  individual  rehabilij^^ation  are  offered. 

"  During  tlie  last  five  years  the  joint  board  of  sanitary  control  of  New  York 
Las  had  the  supervision  of  the  tuberculo.s'is  benefits  in  several  locals  of  the 
International  Ladies  Garment  Workers'  Union,  with  a  membership  of  about 
20,000.  We  have  had  about  350  to  400  cases  under  oiu'  jurisdiction,  and  215 
of  them  have  been  placed  in  various  boarding  houses  and  sanatoria  for  a  more 
or  less  lengthy  sojourn.  Our  records  show  that  of  the  215  cases,  92,  or  nearly 
43  per  cent,  have  returned  to  their  o^vn  industry,  37  joined  other  trades,  while 
8  left  tlie  State,  13  died,  6  are  still  under  treatment,  and  the  fate  of  59  is 
nidcnown.  This  shows  that  by  far  the  largest  number  of  our  posttuberculous 
workers  have  rejoined  their  industry  or  gone  to  other  trades." 

Dr.  George  :\I.  Price,  medical  director,  reports  tliat  the  most  difficult  problem 
is  what  to  do  with  those  men  or  women  wiio  have  been  at  sanatoria  or  other 
places  and  have  had  their  disease  arrested  or  cured.  In  a  great  many  cases 
it  was  felt  that  these  workers  were  not  fit  to  undertalce  .strenuous  toil  in  their 
own  Industry  and  should  have  had  either  graduated  work  in  their  own  trade 
or  some  lighter  occupations  in  other  trades.  "  It  was  also  imperative,"  he  con- 
tinues, "  to  have  a  complete  control  and  supervision  over  these  work(?rs,  to 
have  them  examined  periodically,  to  see  their  families,  and,  in  general,  to  con- 
trol their  reliabilitation  and  their  reentrance  into  industrial  and  social  life." 
lie  ndvi.ses  tlie  establishment  of  numerous  "  jiosttuberculous  workshops"  as 
one  of  the  methods  to  be  used  in  the  i-olutiou  of  tlie  problem,  but  points  out 


23 

that  there  are  a  number  of  workoj's  who  are  ixirlmjw  uiihl.  U)  work  inHhle  of 
shops,  and  for  whom  It  may  be  neces.sury  to  establish  Industrial  farfn  oolonieH. 

DistMK'tly  better  rc^Hults  are  rei)<)rlyed  by  Dr.  D,  U.  Lyn)un  In  dealhi^  with  a 
vei-y  dillijnuit  clasa  of  patients  tliun  those  found  in  New  York  City  unri  Massu- 
duis(>tts. 

At  the  close  of  the  hrst  10  y<'ars  of  worit  at  tlie  Cnylord  I''ani)  Sun.-itorium, 
WallJn.t?ford,  Conn.,  it  was  found  tliat  about  22  of  their  ],J]2  eases  liad  be«!n 
lost  track  of.  "Wiiile  $400,477  liiid  been  expended  on  the  institution  (including 
5  per  cent  interest  on  construction  find  equiitment),  the  discharged  patienta 
had  already  earned  $1,339,000,  or  almost  $940,000  more  than  the  entire  ex- 
penditure in  their  beh-alf. 

The  records  show  that  factory  worltei-s  held  their  conrlltion  distinctly  l>ettf;r, 
and  the  office  work-ers  far  l>etter  than  did  outdoor  workers. 

Dr.  Lyman  ascribes  the  excellent  economic  and  piiysical  results  chiefly  to 
wages  and  environment.  Of  344  men  who  had  stated  their  earnings,  only  13 
M'ere  earning  $10  or  less  a  week.  Two-thirds  were  earning  over  $li^>  a  week. 
The  average  for  the  344  was  $21.37.  (The  average  weekly  earnings  of  all 
patients,  both  men  and  women,  at  Otisviile,  New  York  City's  sanatorium,  wan 
but  $9.81.  An  allowance  of  $9  a  week  for  women  doing  their  own  housework 
was  included  in  this  average.) 

The  following  statement  by  Dr.  Lyman  regarding  the  prejudices  of  fellow 
workmen  is  interesting  and  significant : 

"  We  asked  each  of  our  old  patients  this  question :  Has  the  fact  that  you 
have  been  at  a  sanatorium  given  rise  to  any  unpleasant  experiences  with  your 
neighbors  or  fellow  employees?  Six  hundred  and  thirty -three  an.swered  this 
question ;  500  stated  that  they  had  never  had  any  tx'ouble  of  the  kind,  and 
quite  a  few  of  the  43  who  reported  such  experiences  stated  that  they  had  been 
of  a  very  trivial  character ;  in  other  words,  the  facts  as  shown  from  these  let- 
ters are  quite  different  from  the  general  conception  of  the  situation."  Un- 
fortunately, a  similar  question  relative  to  employers  was  not  asked. 

The  report  emphasizes  the  necessity  of  a  more  highly  developed  follow-up 
service  to  "  procure  more  permanent  results  from  the  patient,  and  to  aid  in 
amassing  data  on  housing,  living,  and  industrial  conditions,  to  control  tuber- 
culosis, the  chief  determining  factors  of  the  incidence  of  disease  in  that 
locality — ^the  problem  usually  varying  with  the  locality."     *     *     * 


IDepartment   of   Health,    City   of   New   York,    Monograplx    Series   No.    8,    October,    1913, 

pp.  32,  34.] 

The  majority  of  sanatoria  seem  disinclined  to  keep  patients  longer  than 
six  months,  the  plea  advanced  by  some  being  that  in  this  length  of  time  the 
patient  will  gain  what  the  sanatorium  can  give  him  and  also  that  a  greater  num- 
ber can  be  admitted  aiid  so  benefited.  We  believe  it  should  strongly  be  urged  that 
curable  cases  be  kept  for  a  longer  period  or  until  completely  recovered..  The 
establishment  of  industrial  colonies  mentioned  below  might  obviate  the  neces- 
sity for  this,  but  pending  their  establishment  a  longer  period  in  the  sanatorium 
for  curable  cases  would  seem  advisable. 

"  Country  colonies  for  tuberculous  individuals,  or  for  patients  with  their 
families,  might  well  be  tried  as  a  possible  help  in  the  solution  of  the  problem 
of  occupation  and  of  increased  length  and  care  and  treatment  in  order  to 
build  solidly  for  health.  Those  restored  could  then  return  to  normal  life, 
while  the  incurable,  according  to  their  condition,  could  be  ti'ansferred  to 
hospitals  or  other  colonies,  where  proper  living  conditions,  medical  and  sanitary 
care,  and  suitable  occupations  would  be  provided  for  patient  and  family. 
There  would  seem  to  be  opportuuity  in  such  colonies  for  valuable  experimenta- 


24 

tion  in  flower  and  fruit  and  vt'.irotulde  culture,  trurlc  farniinix.  i>oultry,  squab 
raisin;:,  etc.,  and  even  in  some  industries  winch  could  be  conducted  in  the  open 
air  or  in  roofe<.l-over  places,  practically  open  air." 

[Fourth  Annoal  Meeting,  Nntlonal  Tuberculosis  Association,  Dr.  Charlis  J.  Ilutfitld.] 

Early  attention  has  been  .iriven  by  the  directors  of  sanatoria  to  the  possibility 
of  developing  convalescent  farms  to  n'ceive  cases  on  disrharj;e,  and  a  few  inter- 
esting experiui(»nts  liave  been  made.  Of.  tlie.se  the  Saranac  Lalcc  Industrial  Set- 
tlement is  an  example.  The  settlement  was  established  in  May,  1907,  on  a  plot 
of  ground  on  the  outskirts  of  the  village.  The  following  is  a  partial  quotation 
from  the  article  in  "Charities  and  the  Commons,"  by  Jlr.  W.  E.  D.  Scott:  "The 
purpose  of  the  .settlement  was  to  try  to  find  proper  hyj.'ienic  work  and  conditions 
inuler  wliich  convalescent  con.sumptives  miglit  earn  .sullicicnt  wages  to  enable 
tlh-ni  to  prolong  their  stay  in  tlie  neighborliood  of  (h-i  sanatorium  until  further 
I»rogress  in  recovery  was  made  certain.  At  the  same  time,  it  was  IioikhI  that  the 
education  in  some  healthful  pursuit  might  make  tiie  future  life  of  the  indi- 
vidual an  indei)endent  one.  During  the  lirst  six  months  of  the  settlement's 
existence  31  persons  had  either  temporary  or  continuous  employment.  The 
w.iges  paid  ranged  from  15  to  20  cents  an  hour.  Tlie  industries  tried  were 
gardenintr,  poultry,  leather  work,  diet  kitchen,  .sewing,  mending,  and  an  exchange 
for  the  sale  of  articles  made  by  invalids  in  their  liomes."  Unfortunately  the 
ex'periuient  was  discontinued  after  a  trial  of  less  th.in  a  year,  because  the  late 
tinancial  stringency  made  impossible  the  raising  of  the  necessary  funds  for 
maintenance.  Owing  to  the  .short  period  of  operation,  no  detiuite  conclusions 
could  be  reachetl.  The  element  in  the  plan  that  provided  for  the  education  of 
indoor  workers  in  outdoor  occupations  is  especially  noteworthy,  and  should  be 
carefully  considered  in  all  experiments  of  the  kind.     *     *     * 

IJefore  leaving  the  consideration  of  farm  colonies  as  a  partial  solution  of  the 
prolilem  of  giving  employment  to  convalescent  consumptives,  it  may  be  well  to 
enumerate  some  of  the  obstacles  to  their  success.  In  the  first  place,  the  capital 
invested  is  almost  always  very  large  in  proportion  to  the  number  of  ex-patients 
tliat  can  be  benefited;  thus  the  per  capita  cost  of  maintenance  is  greatly  in- 
creased by  the  interest  on.  the  investment.  Then  the  class  of  patients  who  can 
take  up  the  work  with  profit  to  themselves  and  to  the  farm  is  relatively  small. 
By  far  the  greater  number  of  the  inmates  in  our  charitable  and  semicharitable 
institutions  are  city  and  town  bred.  They  have  no  ability  or  taste  for  farm 
work.  A  stay  at  the  convalescent  farm  means  a  prolongation  of  separation  from 
the  families,  unless,  indeed,  as  at  the  Stony  Wold  Sanatorium,  provision  is 
made  for  families  also;  and  if  the  families  are  provide<l  for,  still  fewer 
patients  can  be  accommodated.     *     *     * 

Farm  colonies  for  consumptive  convalescents  should  be  thoroughly  tested. 
The  plan  of  educating  indoor  workers  in  outdoor  occupations  should  be  kept 
in  jnind.  When  po.ssible  the  families  of  ex-patients  should  be  looked  after,  and 
should  be  encouraged  to  assume  the  care  of  the  sick  member. 


[Biglitb    Annual    Meclins,    National    Tuberculosis   Association,    I>r.    S.    Adulpbus    Knopf, 

p.  167.] 

Suitable  work  some  time  prior  to  and  after  the  arrest  or  cure  of  tlie  di.sease 
is,  to  my  mind,  of  incalculable  value  to  the-patient.  By  suitable  work  I  mean 
to  suit  the  physique  and  the  mind  of  the  patient;  work  which  makes  him 
happy  and  contenteil — In  other  words,  a  pleasant  occupation. 

Such  occujnition  therapy  during  the  convalescent  stage,  under  proper  super- 
vision, will  help  to  solve  the  problem  of  what  to  do  with  the  countless  number 
of  patients  who  can  not  remain  long  enough  in  institutions.     I  would,  there- 


25 

foro,  vory  Rtron;;?ly  advocate  a  moverru-nt  creating  what  I  would  wIhIi  to  call 
"  iiitoriiiodiate  slalions."  Here  the  roeovorod  tiil)erfMiloti.s  piitieiit  kIioiiUI,  if 
at  all  possible,  find  work  with  which  he  is  familiar,  with  which  he.  has  before 
earned  his  liviuf^,  and  with  wliicli  he  will  have  to  earn  Ids  living  tlu-R'afler. 
'JMius,  for  example,  if  a  man  has  been  a  tailor,  let  liim  do  soitif  liillorinfr; 
if  ho  has  been  u  shoemaker,  let  him  do  shoemaking ;  if  lie  has  l;ceii  a  book- 
binder, let  him  do  bookbinding;  and  so  on.  It  Roes  without  sayinR  that  these 
intermediate  stations  should  be  models  of  sanitation  and  that  all  work  which 
can  be  so  done  should  be  done  outdoors.  Such  intermediate  stations  should  be 
institutions  supported  by  the  Stale  or  municipalities,  for  it  Is  the  common- 
wealth which  will  be  particularly  benefit t-d  by  a  greatly  reduced  number  of 
relapses.  Thus  a  true  financial  gain  will  in  tin;  end  accrue  to  the  comnion- 
AA'oaKh  from  the  establishment  of  such  intcu-mediate  health  or  sanitary  work 
stations. 


[Maj.  r.  Ilovion-Smilh  Hartley,  C.  V.  O.,  ]\I.  D.,  F.  R.  C.  P.,  honorary  advisc-r  on  tiiijfr- 
culosis  to  the  ministry  of  pensions  antl  to  the  comniitlcc  on  inKiUiitional  treatment 
appointed  by  the  minister  of  pensions.] 

Writing  on  "  Tuberculosis  in  its  relation  to  the  war  "  he  says : 
When  the  sanatorium  movement  was  first  initiated  it  was  hoped  that  the 
arrest  or  improvement  in  the  disease  thus  obtained  in  many  cases  would  be 
permanent.  It  was  soon  found,  however,  that  from  one  cause  or  another,  and 
after  a  longer  or  sliorter  interval,  a  large  proportion  of  cases  broke  down  again. 
A  movement,  initiated  by  Sir  Robert  Philip,  of  Edinburgh,  has  consequently 
sprung  up  to  start  what  are  knovv'n  as  "  farm  colonies,"  to  wliich  the  patient 
may  be  drafted  after  leaving  the  sanatorium,  and  where  he  may  stay  for  a 
year,  it  being  hoped  that  by  prolonged  treatment  of  this  kind  the  arrest  of 
las  disease  may  be  consolidated,  and  a  much  larger  proportion  of  cases  remain 
well  after  discharge.  During  his  stay  training  v/ould  be  combined  with  treat- 
ment, and  the  patient  would  learn  market  gardening,  agricultural  work,  pig- 
keeping,  beekeeping,  poultry  farming,  and  to  some  degree  dairy  work,  and 
possibly  forestry,  so  that  on  leaving  he  would  be  in  a  position  to  take  up  a 
small  holding  or  large  allotment,  or  possibly  work  a  small  farm  on  cooperative 
principles,  with  other  patients  whose  friendship  he  has  made  while  in  the 
institution.  In  other  cases  the  patient  would  return  to  his  former  occupa- 
tion, provided  it  can  be  carried  on  under  good  environment.  No  doubt,  too, 
as  such  colonies  develop  training  in  certain  trades,  which  can  afterwards  be 
carried  on  under  healthy  conditions,  will  be  added,  and  such  industrial  train- 
ing may  become  the  most  important  element  in  the  scheme,  the  colony  thus 
becoming  an  "open-air  training  colonj^ "  rather  than  a  simple  "farm  colony." 
(Recalled  to  Life,  No.  2,  September,  1917.) 


[British  Medical  Journal,  London,  lOlS,  I,  Feb.  2.] 

This  journal  refers  to  farm  colonies  in  the  treatment  of  tuberculosis  as 
follows : 

Experience  at  the  Royal  Victoria  Hospital,  Edinburgh,  has  shown  that  in  a 
considerable  number  of  cases  complete  arrest  of  tuberculosis  could  not  be 
attained  within  the  ordinary  time  limit  of  sanatorium  residence.  It  was  found 
that  within  four  or  five  years  some  50  per  cent  of  patients  apparently  cured 
had  relapsed.  The  average  duration  of  sanatorium  treatment  was  six  months. 
If,  under  the  present  insurance  act,  the  treatment  is  reduced  to  three  months 


26 

the  results  will  l>o  much  worsr.  Kvoii  ii  iIk-  dur:itioii  of  sanaturiuiu  trentinoiit 
is  u<»t  rtHluotHl  it  wmilil  be  dt^iralile  in  from  -0  to  Ho  per  ceiu  of  the  cases  lo 
coutiuue  the  treutaient  in  a  farm  colony.  For  a  certain  number  of  patients 
tlie  only  lioiu^fnl  outlook  after  cure  is  to  continue  an  outdoor  lif<'.  Tiie  work 
of  the  Koyul  Victoria  H«»spital  Farm  Colony,  establishtHl  in  1910,  1ms  been 
very  Siitisfactorj  iu  spite  of  the  disturbances  of  the  war.  Almost  nil  the 
patients  were  kept  iu  residence  for  12  mouths  and  discharged  with  the  disease 
arrestetl  and  with  a  lirst-rate  working  capiicity ;  and  these  were  all  cases  in 
which  sanatorium  treatment,  eveu  exceeding;  six  mouths,  failed  to  8t>cure  di'- 
cisive  results.  Tiiey  were  typical  cast-s,  whidi  woulil  have  gone  to  swell  tlie  roll 
of  sanatt>rium  failures. 


[Modern  rio.spltal,  September,    l'.)IS:   lied   Tii.iiit,'le  TulxTCulosls   Farm   Colony.] 

The  Natiomd  t'ouncil  of  Youuk  Men's  Christian  Associations  has  purchastvl 
30  acres  of  land  at  Kiuson,  iu  Dorset,  where  it  has  established  a  farm  colony 
for  tuberculous  soldiers.  Ouly  {)atieuts  iu  the  early  stages  of  tlie  disease  are 
accepted.  The  men  live  in  wooden  chalets,  distributed  over  u  sheltered  and 
wooded  portion  of  the  estate,  Each  chalet  is  divided  into  two  sections,  e;i(h 
containing  two  beds.  The  central  building  contains  dining  and  recreation 
rooms,  kitchen,  and  oflices.  The  work  is  graduated.  It  con.sists  of  cultivating 
vegetables  and  fruits,  keeping  bees,  rearing  of  poultry  and  pigs,  etc.  More 
exten-sive  farming  operations,  however,  will  be  undertaken  later.  The  colonists 
receive  1  shilling  each  working  day.  Tlie  aim  of  tlie  institution  is  not  only  to 
cure  the  patients  but  to  give  them  a  training  which  will  enable  them  practically 
to  begin  life  again. 


[Extract  from  British  Journal  df  TiilxTculosis,  by  Andrew  Trimble.] 

The  "  old  methods,"  tried  and  found  wanting  before  the  war,  are  being 
strained  to  tlie  utmost,  and  the  death  I'ate  steadily  increases.  Three  months'  or 
eA-en  six  months'  treatment  at  a  sanatorium,  followt^d  by  a  return  to  the  conditions 
under  which  the  disease  was  contracted,  has  b(^n  shown  to  be  worse  than  useless. 
Has  not  tlie  time  arrived  to  take  stock  of  the  po.sition,  find  out  where  our  present 
system  fails,  and,  in  tlie  light  of  experience,  try  to  make  good  its  defects?  The 
principles  of  sanatorium  ti'eatment  are  sound  enough ;  it  is  the  application  of 
these  principles  in  the  case  of  the  workingmau  that  is  at  fault.  Our  sanatoria 
are  filled,  for  the  most  part,  with  cases  more  suitable  for  hospital  than  for 
sanatorium  treatment;  but  they  are  religiously  put  through  the  regulation  three 
months'  treatment  and  then  as  religiously  discharged ;  for  the  whole  thing  has 
become  a  ritual.  What  becomes  of  these  cases?  They  go  to  swell  the  ranks  of 
the  unemployed  and  unemployable,  and  thus  become  a  burden  to  the  community. 
They  constitute  by  far  tlie  greatest  number  of  cases  of  tuberculosis,  fill  the  out- 
patient departments  of  our  ho.spitals  and  dispensaries,  and  are  the  means  of 
spreading  the  dis«*ase  and  gathering  in  ever-new  victims.  Is  this  state  of  affairs 
to  be  allowed  to  remain  unchanged?  Granted  that  better  means  of  early  diag- 
nosis will  improve  the  situation,  with  the  medical  profession  as  now  constituted, 
It  will  take  at  least  a  generation  before  any  uew  means  will  be  generally 
adopted.  We  must,  however,  act  now,  and,  at  any  rate  in  the  case  of  our  dis- 
charged soldiers  and  sailors,  see  that  the  old  methods  are  not  applied.  For- 
tunately, the  pensions  ministry  is  becoming  aware  of  the  magnitude  of  the 
danger,  and  public  opinion  is  gradually  hardening  to  the  view  that  there  must 
be  less  tinkering  with  the  question  and  a  more  thorough  method  of  tackling  it 
adopted.     Elquality  of  opiwrlunily  must  be  given  to  all  cases  of  tuberculosis 


27 

(ii«clmrf?(>(l  from  tlio  servioe«.  Proloii^'fd  trfjatnionfc  must  b(^  avail«bl(;,  first  at 
a  saiiJitonuin  ctoloiiy  and  tlion  ut  an  huhiMtrial  colony.  Aflc-rwai-ds  tin;  canea 
imist  I)(^  l'ollow(!d  up  by  a  rational  .systoiri  of  aftor  can;;  nothing  .short  of  this 
.slioidd  b(>  tok'i-atcMl.  A  community,  which  would  becoiiui  larf^cly  H(!ir-HU|M""'tirig 
in  timo,  .should  bo  stiirted — a  colony  HU(;h  as  that  in  courses  of  conHtruction  at 
I'apworth,  in  Cambridgeshire — wlujre  ex-service  men  sufreriiig  from  tubercu- 
lo.sis  may  reside,  their  xlifliculties  appreciated  and  overcome,  their  lives  made 
Ii:q)py  l)y  the  thou;:?ht  that  they  are  not  wandering  about  in  a  hopeless  fashion, 
unemployed  and,  above  all,  shunned  by  their  fellows,  but  are  enKaged  In  re- 
munerative woi*k,  for  however  small  a  number  of  hours  daily,  assisted  by  the 
State,  and  no  loniccer  constitntinft-  a  danf,'or  to  the  general  community.  Kotldng 
short  of  such  a  comi)rehenHive  scheme  should  find  favor  with  the  mass  of 
mtKlical  and  lay  opinion,  other  than  that  already  pi-e.judif^ed  by  in*(H'onceived 
o[)inions.  Let  us  bear  in  mind  that  it  is  impossible  to  turn  a  mechanic  into  a 
farm  laborer,  and  that  a  light  open-air  job  is  not  the  same  thing  as  farmv/orlj, 
and  that  in  any  case  light  jobs  u;sually  mean  light  wage.^j  at  the  end  of  the  week, 
llather  let  us  help  to  demonstrate  that  many  trades,  when  carried  on  under  ideal 
conditions,  can  be  undertaken  by  consumj)tives  without  any  detriment  to  their 
health.  We  may  thus  help  to  bring  about  the  time  when  all  cases  of  tubercu- 
losis will  be  treated  at  a  colony,  and  not  be  allowed  to  drift  back  to  sun-ound- 
ings  in  which  they  can  infect  others.  The  day  of  a  short  stay  at  a  sanal  oriiim 
and  a  quick  return  to  the  workaday  world  is,  we  hope,  fast  receding,  and  this 
will  come  about  all  the  more  quickly  if  we  face  the  facts  and  refrain  from 
hiding  our  heads  in  the  sands  of  complacency.  It  must  be  recognized  that  a 
consumptive  workingman  vi'ith  the  disease  arrested  is  only  capable  of  doing  a 
certain  percentage  of  the  work  of  that  accomplished  by  a  healthy  man ;  this 
must  be  accepted  as  a  fundamental  truth.  Subsidize  the  man's  labor  and  let 
him  live  under  ideal  conditions.  Let  the  pensions  now  given  to  tuberculous 
ex-soldiers  be  used  for  this  purpose — for  the  man's  own  use — while  he  is 
shielded  from  the  iierce  competition  to  which  he  must  otherwise  succumb. 
When  treatment  and  prevention  go  hand  in  hand,  the  "  arrest "  of  tuberculosis 
will  be  in  sight. 


[War  Pensions  Gazette,   January,   lOlS  :  Advantages  of  the  colony   treatment  over  tlie 

sanatorium.] 

It  is  a  matter  of  general  knov/ledge  that  while  manj'  consumptives  of  the 
better  classes  are  restored  permanently  to  health  and  capacity  for  work  as  the 
result  of  treatment  and  education  iu  a  sanatorium,  yet,  on  the  otlier  hand,  the 
statistics  of  sanatoria  for  the  working  classes  give  a  discouraging  picture  of 
what  institutional  treatment  can  effect  for  them.  But  the  factors  which  make 
for  failure  are  equally  well  appreciated ;  these  are  too  short  a  duration  of  treat- 
ment in  the  sanatorium,  discharge  in  a  State  of  incomplete  cure,  and  return  to 
unfavox'able  conditions,  such  as  unhealthy  occupation,  uncertain  or  inadequate 
wage,  or  unsatisfactory  housing.  To  teach  the  consumptiTe  of  the  working 
classes  an  occupation  which  promises  him  his  normal  standard  of  livelihood, 
and  a  healthy  environment,  would  be  to  solve,  at  any  rate  to  a  large  extent,  the 
diflk'ult  problem  which  he  presents.  Alternatively,  to  give  him  some  12  months' 
treatment  instead  of  two  or  three,  and  meanwhile  io  make  an  adequate  provi- 
sion for  his  dependents,  would,  apart  from  any  reeducation,  impxove  his  out- 
look materially.  He  would  return  to  his  home  farther  advaiiced  on  the  road  to 
reco-very,  so  that  with  some  aftercare,  such  as  shortening  the  hours  of  work,  and 
for  a  time  at  least  some  financial  assistance,  he  might  in  many  instances  reLurn 
to  his  ordinary  occupation  with  no  little  success. 


28 

Ai;riculiural  work  of  stuue  kind  is  most  coimnonly  iiropostHl — senonil  fanninfr, 
market  gardening;,  fruit  growing,  poultry  rearing,  etc.  Latterly  the  success  iu 
rotvlucating  the  disablefl  soldier  has  suggested  the  teaching  of  some  of  tlu> 
tradt>s  wliifli  can  be  followed  without  detriment  to  healtli,  such  as  carpentry, 
simple  mechanics,  various  kiiuls  <>r  luuulicrafts. 


[Rritish  Journal  of  Tuberculosis:  A  symposium.] 

The  British  Journal  of  Tuberculosis  has  endeavored  during  the  strenuous 
years  of  war  to  concentrate  attention  on  practical  aspects  of  tlie  conllict  against 
tuberculosis.  The  light  for  the  prevention  and  arrest  of  tuberculosis  calls  for 
n  systematically  arranged,  scieutilically  conducted,  continuou.sly  applied,  com- 
plete service.  In  this  campaign  highly  organized  forces  and  effectively  coordi- 
nated schemes  for  attack  are  essential  if  any  real  success  is  to  be  attained. 
I>uring  recent  days  many  have  advocated  the  establishment  of  colonics  for  the 
(uberculou.s.  The  tuberculosis  colony  uudoulitetlly  deserves  a  place  in  any  com- 
plete system  for  dealing  with  tuberculous  and  tuberculously  disposed  cases. 
IJut  wide  differences  of  opinion  exist  regarding  the  nature,  organization,  admin- 
istration, scope,  limitations,  and  general  effectiveness  of  a  tuberculosis  colony. 
There  are  but  few  experiments  sufficiently  complete  to  afford  grounds  for  the 
formation  of  governing  principles.  We  have  therefore  gathered  a  number  of 
expressions  of  opinion  from  experts  who,  as  serious  students  of  the  problem  or 
from  actual  experience  and  experiment,  are  in  a  position  to  present  diita  and 
afford  advice  which  we  believe  will  lie  invaluable  in  directing  the  way  toward 
rational  conclusions.     (Editor.) 

Until  some  one  has  the  courage,  whether  by  means  of  a  colony  or  otherwise, 
to  tackle  this  mass  of  infection — that  is,  the  mass  of  middle  cases,  of  men  who 
can  only  do  30  to  50  per  cent  of  the  worlv  of  a  normal  man — it  is  not  much  good 
talking  about  the  eradication  of  tuberculosis.  The  colony,  therefore,  should 
really  be  a  community,  with  a  central  institution  for  advanced  patients  where 
they  may  be  nursed  and  tended  to  the  last.  A  separate  part  of  the  estate  should 
be  marked  off  where  varied  and  definite  trades  should  bo  arranged,  so  that  each 
patient  may  be  engaged  in  an  occupation  which  is  as  nearly  like  his  old  trade  as 
possible;  and  tliese  patients  should  be  housed  in  specially  constructed  open-air 
shelters.  Between  those  two  extremes  there  sliouUl  be  a  connecting  link,  the 
training  .settlement  for  the  mass  of  middle  cases,  which  may  in  the  one  event 
be  passed  into  the  industrial  part  of  the  community,  or  in  the  other  be  cared 
for  in  the  central  institution.  (From  Sir  Clifford  Allbutt  and  P.  C.  Varrier- 
Jones. ) 

The  conception  of  the  farm  colony  for  the  treatment  of  tuberculosis  offers, 
in  my  view,  more  hope  of  success  than  is  likely  to  be  attained  by  .sanatorium 
treatment.  I  have  always  held  the  opinion,  which  is  strengthened  by  experi- 
ence, that  the  results  attained  by  the  latter  method  are  in  no  sense  conmien- 
surate  with  the  cost  entailed,  and  I  do  feel  assured  that  in  time  it  will  be  gen- 
erally recognized  that  large  sums  laid  out  on  preventive  measures,  including 
prominently  better  housing  conditions,  will  be  generally  adopted  in  preference 
to  a  continuation  of  our  present  methods. 

For  the  greater  part  of  the  year  a  very  small  numb>^r  of  workers  is  sufficient 
for  the  agricultural  necessities.  Experience  in  connection  with  Polton  Farm 
Colony  indicates  that  besides  the  ordinary  branches  of  agriculture,  with,  in 


29 

ndflition,  the  in(histry  of  pip;  brocdiiit;  on  a  lar^r^  sculo,  there  in  tho  necessity 
for  some  other  productive  opeii-nir  o<'C'iij)atlon  which  would  l<ccp  tlie  p<;rsons 
under  tn^atment  employed  tlirouKhout  tix;  wliolo  year.  Uwl'iil  industries,  there- 
fore, connected  with  joinery,  ciibinetinaidriK,  fret\vorl<,  hootnial<irij?,  and  such 
hl<e,  seem  essential  additions  to  tho  conception  of  a  farm  colony  as  Buch, 
(From  A.  Maxwell  Williamson.) 


One  of  the  roasonfl  for  tho  d(\siKiiaiion  "farm  colony"  wn«  lo  (■■iialiie  the 
colonist  to  obtain  employment  without  being  labeled  nn  Invalid,  thereby  tend- 
ing to  reduce  his  marlvct  value.  But  while  farming  operations  form  a  flistinc- 
tive  featur(>,  other  industries  are  not  excluded,  such  as  forestry,  with  its  vari- 
ous ramilications,  market  gardening,  industrial  workshops,  etc.  Nor  is  any 
colony  complete  without  an  open-air  school  for  children.  Hairmyres  Colony 
embraces  the  above  features  and  holds  in  it  all  the  elements  of  success.  It  is 
capable  of  indefinite  expansion.  Patients  that  no  longer  require  the  services 
of  a  nursing  staff:  are  transferred  to  the  colony,  thus  relieving  pressure  on  the 
sanatorium.  The  sclieme  is  a  practical  one,  based  on  sound  economic  and 
educative  lines.  Its  object  is  to  so  treat  and  train  a  patient  for  a  prolonged 
period  under  medical  supervision,  and  thus  enable  him  to  earn  a  livelihood 
under  suitable  conditions,  the  risk  of  relapse  being  reduced  to  the  minimum. 
It  conserves  and  maintains  working  capacity.  The  great  variety  of  occupa- 
tions created  by  the  activities  of  a  well-organized  colony  arouse  and  sustain 
interest,  thereby  reflecting  on  the  physical  and  mental  well-being  of  the  col- 
onist. That  restless  dissatisfaction,  frequently  a  disquieting  feature  in  sana- 
toriums,  is  seldom  met  with. 

There  are  three  strong  arguments  against  the  colony  system  which  can  be 
obliterated  by  legislation,  viz,  (1)  inability  to  commandeer  for  treatment  the 
very  early  cases  of  tuberculosis,  (2)  to  retain  those  eases  without  interruption 
till  a  permanent  arrestment,  or  otherwise,  is  effected,  (3)  the  vexed  question  of 
dealing  with  dependents.  None  of  these  arguments,  however,  detract  from  the 
efficiency  of  the  scheme  for  the  attainment  of  the  object  for  which  it  was 
created.     (A.  H.  Macpherson.) 


Such  colonies  must  be  founded  on  a  much  broader  basis  than  the  "  farm 
colony  "  of  the  past,  which  has  been  of  limited  iitility  where  the  majority  of 
patients  was  drawn  from  a  rural  population,  and  has  been  even  less  useful  for 
cases  coming  from  an  urban  district.     (Godfrey  Brookes  Dixon.) 

Sanatorium  treatment  must  in  many  cases  be  followed  by  proper  aftercare, 
and  this  could  be  best  provided  in  a  colony.  There  are,  however,  many  intrinsic 
and  administrative  obstacles.  It  is  notoriously  difficult  to  persuade  the  town 
dweller,  and  especially  when  he  is  a  skilled  artisan  accustomed  to  a  high  rate  of 
wages,  to  adopt  a  country  life  and  an  outdoor  occupation  even  for  a  year  or  tr^-o. 
Many  of  the  colonists  would  wish  to  leave,  without  regard  to  medical  advice,  as 
soon  as  they  thought  they  had  acquired  sufficient  knowledge  to  make  their 
services  of  any  real  commercial  value.  Adequate  provision  and  accommodation 
would  have  to  be  made  for  the  dependents  of  married  patients,  which  would 
mean  a  considerable  financial  outlay,  for  which  voluntary  enterprise  and  prob- 
ably State  action  is  unprepared.  The  patients  could  be  maintained  at  less  cost 
in  a  colony  than  in  a  sanatorium,  but  it  is  extremely  doubtful  if  colonies  could  be 
made  self-supporting.  Experiments  on  a  small  scale  do  not  provide  the  diffi- 
culties which  will  present  themselves  if  large  numbers  are  to  be  colonized. 
(AY.  G.  Kinton.) 


30 

The  colony  sliould  laler  for  piiki'd  rases  ilischarjred  from  sanatoria.  It  is 
uuUkely  that  one  institntion  will  be  able  tt)  provide  a  siillicient  nun)lter  of  such 
cases,  and  therefore  the  colony  should  represent  ii  lariie  KeoKraphical  urea. 
(Niveu  Robertson.) 

I  feel  convinced  that  a  colony  scheme,  properly  mrried  out,  will  prove  1 1n- 
best  means  for  the  speedy  and  complete  eradication  of  tuberculosis.  To  be 
successfid,  h«>wever.  it  must  be  made  thoron;:hly  attractive  to  patients,  and 
must  offer  them  a  hiipitier  and  fuller  life,  as  well  as  better  chances  of  recovery 
or  nmelioratUin,  than  they  can  pet,  as  a  rule,  in  the  general  community.  Tli.- 
Idea!  colony  would  consist  of  a  larpe  village  commuiiity,  where  patients  of  boili 
sexes,  of  nil  classes  and  atxee,  and  at  all  stages  of  the  disease,  would  be  suitably 
provided  for.  The  larger  the  colony  the  better,  as  more  variety  of  occupation 
and  interest  could  be  provided  to  suit  individual  tastes.  The  normal  residential 
unit  .should  be  the  patient's  home,  rather  than  the  tuberculosis  institutioii ; 
e.-H-h  "  home  "  accommodating  patients  of  different  ages  and  of  both  sexes  under 
the  charge  of  resixmsible  house  mother  and  father.  Several  "fannlies"  might 
possess  a  common  kitchen,  dining  room,  etc.  I  believe  this  plan  would  luvivi- 
much  more  satisfactory  than  attempting  to  segregate  the  sexes.  For  acute  or 
advanced  cases  a  nursing  home  or  suitable  hospital  accommodation  would  be 
necessary.  Special  pains  should  be  taken  to  provide  appropriate  and  congenial 
occui»ations  for  the  colonist  patients.  Hours  of  work  should  be  regulated 
according  to  the  capacity  of  the  Individual  and  all  labor  paid  for  in  proportion 
to  its  market  value.  Ample  provision  should  be  made  for  the  education  of  chil- 
dren, for  hygienic  Instruction,  for  the  training  of  patients  in  arts  and  crafts,  and 
in  all  that  pertains  to  good  citizenship.  There  must  also  be  proper  provision  for 
healthy  amusements  and  religious  worship.  Self-government  should  be  intro- 
duced as  far  as  possible  in  conjunction  with  expert  advice  and  direction,  and  the 
residents  must  be  encouraged  in  every  way  to  take  an  interest  and  pride  in  the 
welfare  and  pr6.«T3erity  of  their  colony.  The  general  layout  of  the  village  should 
be  arranged  on  garden  city  lines,  and  all  buildings,  residential  and  other,  must 
be  designed  and  funiished  with  a  view  primai'ily  to  health,  thorough  ventilatioti. 
and  ease  in  cleansing.  Were  a  suflicieut  number  of  such  tubei'culosis  colonies 
established  it  would  become  possible,  I  believe,  without  much  hardship,  to  segre- 
gate all  infectious  cases  out  of  the  general  community,  and  thus  put  a  stop  to 
the  spread  of  tuberculous  disease.     (J.  D.  Esslemeut.) 


[War  Pensions  Gazette,  March,  1919,  p.  279.] 
The  West  Riding  of  Yorkshire  County  Council  have  decided  to  cairy  out  a 
large  scheme  of  land  settlement  for  ex-service  men.  Tlie  sum  of  £100,000  has 
been  voted  to  finance  it,  and  a  salary  of  £1,000  is  offered  for  a  land  agent 
capable  of  supervising  the  undertaking.  It  was  stated  that  the  board  of  agri- 
culture had  promised  their  active  support,  and  that,  though  there  was  still 
much  uncertainty  as  to  the  niimbers  to  be  provided  for,  yet  a  census  had  beeii 
taken  of  the  army  in  France,  which  showed  that  4  per  cent  of  the  men 
serving  there  desired  to  settle  on  the  land. 


[Gertrude  R.  Stein,  employment  secretarj,  Ited  Cross  Institute  for  Crippled  and  Disabled 
Men,  who  has  recently  returned  from  an  extensive  investigation  in  allied  countries.] 

The  more  I  think  of  this  problem  the  more  I  beli(»ve  that  a  garden   city 
such  as  Letchworth  Village  is  one  of  the  few  constructive  solutions  of  the 


31 

tuhorciiloHis  prohlftm.  The  difficulty,  of.  course,  Is  In  conf^ivf^atiiiK  so  many 
tuixM'cnlouM  fumilicH  toj^ollicr  tliut  tlie  w(!ll  in(!ml)ors  of  tli<!  fiiinily  niitclit  r('s«>nt; 
1h(!  fiu't  tliat  the  town  is  Iviiown  a.s  VjoinR  just  for  tiiljcrculou.s  jx^oiilo.  Towns 
like  Donvoi-  and  Colorado  S])rinp;s  ar(>  largely  inliablt<;d  by  tnberrrulous  people, 
however,  and  it  does  not  soA)m  to  liave  injured  their  prot^ress. 

In  traveling  abroad  I  visited  a  great  many  of  the  garden  suburbs,  but  none 
of  them  impressed  ine  as  constructive  and  big  as  did  Letchworth  Village. 
Those  living  in  the  garden  suburbs  must  usually  travel  long  distances  iri 
getting  to  their  work  placH",  while  in  Letchworth  Village  the  men  all  live  right 
near  their  factory.  In  fact,  this  is  one  of  the  special  featun^s  of  the  place. 
In  most  cases,  I  should  say,  the  workmen  only  have  a  five-minutes'  walk  to  their 
factory. 

You  see,  this  town  had  the  tremendous  advantage  of  being  planned  before; 
it  was  built,  and  Bot  just  having  little  parts  tacked  on,  as  most  of  our  cities 
have  grown  up.  By  this  general  planning  it  has  meant  that  there  will  always 
be  much  open  space  around  the  town — in  this  case,  forests.  The  houses  are 
built  distant  enough  from  one  another  that  all  the  rooms  are  light  and  airy. 
The  ]*ents,  as  I  remember,  were  particularly  low.  This  is,  of  course,  due  to  the 
system,  to  the  communal  plan  on  which  the  company  is  being  run.  Tiiere  is  no 
speculation  connected  with  this  scheme,  and  all  tlie  profits  that  there  are  go 
back  into  improving  the  property. 

The  project  has  struck  me  as  one  of  the  most  ideal  things  that  I  have 
ever  seen.  The  buildings  are  beautiful,  well  arranged,  and  the  people  look 
happy  and  satisfied. 

It  would  be  wonderful  if  something  of  this  kind  could  be  started  for  the 
tuberculous  in  this  country. 


[John  Galsworthy  in  Reveille.] 

A  third  plan,  which  miglit  have  to  be  adopted :  A  system  of  Government 
workshops  for  townsmen,  and  of  rural  colonies  for  countrymen,  employing  only 
the  disabled,  at  standard  wages,  and  refusing  no  disabled  man  who  at  any  time 
presented  himself.  Not  disciplinary  institutions,  in  any  w'ay,  just  ordinary 
industries — the  men  living  or  lodging  with  their  families,  outside,  in  the  u.sul;1 
way.  Such  workshops  and  colonies  would,  of  course,  need  formation  and  sup- 
port on  the  most  elastic  scale,  suited  to  good  times  and  bad.  They  might  well  in 
some  years  be  almost  empty,  in  others  full  to  overflowing.  But  if  tliey  existed 
we  should  all  know  that  the  right  to  work  and  a  decent  life  has  been  perma- 
nently secured  to  every  disabled  man.  They  would  probably  be  self-supporting, 
and  would  automatically  form  training  scliools  for  men  who  wished  to  pass  ou 
to  work  again  in  oi>en  competition,  as  the  Lord  Roberts  workshops  do  now  on  a 
small  scale. 


[British  Medical  Journal.  Dec.  21,  1918.] 

A  far  larger  undertaking,  which  sooner  or  later  will  have  to  be  faced,  lies 
before  the  county  and  borough  councils.  It  is  ou  all  hands  agreetl  that  the 
establishment  of  farm  and  industrial  colonies,  where  sufferers  in  every  stage  of 
the  disease  can  be  properly  hoiised  and  profitably  employed,  is  \irgently  needed. 
Tlie  idea  is  no  longer  the  Utopian  dream  that  some  gloomy  critics  have  ridi- 
culed. It  has  been  translated  into  practical  being,  and  one  of  the  most  success- 
ful of  such  colonies  is  to  be  seen  at  Papworth  Hall,  near  Cambridge. 


32 

[Loiter  from  J.  Foster  S.nrlos,  lU-lrlit  votailonal  offlcor  of  the  Federal  Board.] 

Ever  siiU'O  we  niet  iit  tlio  distiict  vncatioiial  Kduvrs*  rdiilVronco  in  Wiisliini,'- 
ton.  (he  midille  of  December,  I  have  been  thinking  over  tlie  question  of  tlie 
right  kind  of  colony  for  men  convalescent  from  tui>erculosis.  We  have  a  great 
many  soldiers  suffering  from  tuberculosis  who  are  treated  well  in  the  sanatoria 
within  our  -district,  but  who,  having  their  disease  arrested,  are  discharged  long 
before  they  acquire  any  real  physical  strength  or  endurance.  A  discourag- 
ingly  large  percentage  of  tliese  men  are  breaking  down  later  on  because  of 
the  absolute  necessity  of  their  doing  too  heavy  work  to  earn  a  living. 

To  my  mind  what  is  nei'ded  is  as  follows:  A  large  acreage;  buildings  in  lirst- 
class  condition,  especially  small  cottages  where  men  could,  if  necessary,  bring 
their  families;  the  entire  colony  to  be  under  the  direction  of  a  business  man- 
ager and  competent  medical  ofliccr,  with  a  staff  including  an  agricultural  ex- 
pert and  such  other  experts  as  would  be  necessary  to  carry  out  competent  and 
practical  instruction  along  all  the  lines  of  work  offered. 

As  to  the  lines  of  work,  inasmuch  as  most  of  our  tuberculosis  cases  are  from 
the  country  or  small  towns,  farming  would  come  lirst,  especially  emphasizing 
the  lighter  forms  of  farming,  such  as  dairying,  poultry  raising,  small  fruits, 
animal  husbandry,  farm  accounting,  and  simple  bookkeeping.  There  should 
also  be  well-equipped  shops  to  toach  meclianical  trades,  such  as  blacksmithing, 
auto  repairing,  farm-tractor  operating  and  repairing,  light  machine-shop  work, 
carpentry,  cabinetmaking,  wood  carving,  and  as  great  a  variety  of  the  wage- 
earning  hand  crafts  as  could  be  developed.  There  should  also  be  a  good  com- 
mercial course,  including  typewriting,  bookkeeping,  business  management,  busi- 
ness law,  etc. 

I  recognize  that  this  contemplates  a  large  plant  and  a  considerable  staff, 
but  it  seems  to  me  that  men  going  there  after  their  tuberculosis  is  arrested 
could  not  only  regain  their  health  in  a  substantial  manner  but  at  the  same 
time  learn  useful  trades  and  occupations,  so  that  when  they  have  completed 
their  year  or  more  of  attendance  they  would  be  fitted  to  carry  on  without  the 
liability  of  breaking  down. 

While  such  a  colony  would  be  expen.sive  at  first,  tlie  work  accomplished  would 
bring  in  a  steadily  increasing  revenue,  and  men  going  to  the  colony  should  re- 
ceive, aside  from  their  treatment  and  the  care  and  oversight  given  them,  a 
small  wage  and  a  percentage  of  profit  sharing  on  the  work  they  do.  This  would 
bring  in  a  fair  amount  if  not  an  entirely  suliicient  revenue  to  carry  on  the 
plant  and  at  the  same  time  put  these  men  on  an  apparently  self-supporting 
basis  and  eliminate  the  charity  phase  of  the  moral  question.  We  find  many 
of  our  soldiers  resenting  the  charity  idea  and  working  to  get  on  their  own 
again,  and  it  would  seem  to  me  that  this  might  be  accomplished  in  some  such 
way  as  above. 


[Noel  Dean  P.ardswell,  M.  V.  O.,  M.  1'.,  VAin.,  F.  K.  C.  T.,  London,  late  medical  superin- 
tendent Kin;,'  Edwaid  VII  Sanatorium,  medical  adviser  to  insurance  committee  for 
county  of  London.] 

Broadly  speaking,  there  are  two  alternative  policies  relative  to  the  treat- 
ment of  the  consumptive  worker ;  either  the  patient  must  be  kept  at  an  insti- 
tution until  he  is  cured  and  can  return  with  reasonable  confidence  to  his  for- 
mer life  and  employment — this  may  be  a  matter  of  years — or,  following  a 
shorter  course  of  sanatorium  treatment,  we  must  so  change  his  environment 
as  to  render  his  conditions  at  home  and  at  woik  sucli  that  recovery  from 
tuberculosis  is  possible.     It  is  the  realization  of  these  facts  that  has  led  to  the 


33 

evolution  of  nftcr-fiiro  orf^iinizjil  ions   iind,   moi-c   ff'fiil  ly,   1o   llif  forifr'iit  ion   of 
colonies  for  consuinpliv<'S. 

The  Uvo  typcfi  of  coiifmniptire  colony. — The  term  "  rolrmy  "  is  iiw^d  to 
(loscTlbe  two  types  of  Institutions.  Tlicso  two  colony  sclicnics,  Uiou^li  linviriK 
much  in  common,  present  certiiin  disf iiulivc  features  wliifli  stiiiridy  <l!ff<T- 
ontiiate  the  one  from  the  other. 

Scheme  1,  associated  with  the  name  of  Sir  Robort  F'Iiili|),  jtrovidcs  for  jm 
institution  for  the  exclusive  reception  of  the  early  and  most  curabh;  cases, 
with  a  view  to  friving  tiiem  prolonged  treatment  and  a  triiiniiiK  in  some  agri- 
cultural employment.  Though  linked  up  with  the  sanatorium  from  wiiich  the 
colonists  are  drawn  and  with  the  other  elements  of  a  comprehensiv*;  anti- 
tuberculosis adnnnistration,  it  is  desif;ned  as  a  separate  institution.  Equipped 
upon  simpler  lines  than  sanatorium,  it  is  less  costly  to  administer.  More- 
over, the  patients,  by  performing  useful  work  in  the  institution  and  in  the 
grounds,  gardens,  and  farm,  are  able  to  reduce  somewhat  the  cost  of  their 
maintenance.  To  give  the  favorable  case  some  12  or  18  months'  institutional 
treatment  in  place  of  the  more  usual  period  of  three  to  four  months  should, 
apart  from  any  question  of  reeducatioji,  appreciably  improve  his  outlook. 
The  patient  returns  home,  having  made  substantial  progress  on  the  road  to 
i-ecovery.  With  some  aftercare  he  may  be  expected,  in  many  instances,  to 
altempt  successfully  a  return  to  his  ordinary  life  and  employment. 

Scheme  2  is  more  comprehensive  in  scope,  in  that  it  makes  provision  for 
all  kinds  of  cases,  irrespective  of  the  extent  and  character  of  their  disease. 
Thus  it  comprises,  under  the  same  administration,  a  sanatorium,  a  colony  as 
in  Scheme  1  for  vocational  training,  and  a  home  for  advanced  cases.  The 
opportunity  for  occupation  and  vocational  training,  however,  is  not  limited 
to  the  most  favorable  cases,  but  is  offered  to  every  patient  who  desires  it 
and  who  has  a  prospect  of  some  degree  of  restoration  of  working  capacity. 
Further,  recognizing  that  many  patients  can  never  be  so  restored  to  health  as 
to  be  able  to  hold  their  own  in  the  open  labor  market,  the  colony  seeks  to 
establish  suitable  trades  and  industries  which,  by  offering  remunerative  em- 
ployment under  favorable  conditions,  will  not  only  give  scope  for  reeduca- 
tion, but  encourage  the  permanent  settlement  in  the  neighborhood  of  the 
colony  of  ex-patients  and  their  families,  thus  forming  the  nucleus  of  a  com- 
munity living  under  the  healthy  conditions  of  a  garden  city.  It  is  hoped 
that  by  this  means  the  voluntary  segregation  of  the  consumptive  will  gi-ad- 
ually  be  achieved. 

A  description  of  one  of  these  colonies  will  be  of  interest. 

The  Papworth  Colony,  directed  by  Dr.  Varrier-Jones,  is  a  development  of 
tlie  earlier  pnterprise  carried  out  at  Bourn.  Its  characteristic  features  have 
already  been  referred  to. 

The  colony  comprises  a  large  mansion,  with  grounds  of  16  acres,  which  include 
a  large  walled-in  kitchen,  garden,  and  orchard,  and  100  acres  (now  greatly  in- 
creased) of  agricultural  land.  The  mansion  is  devoted  to  administrative  pur- 
poses and  to  the  accommodation  of  advanced  cases.  Accommodation  for  the  more 
favorable  cases  is  furnished  by  shelters  built  in  the  grounds.  To  pro^-ide  means 
of  useful  employment  for  the  patients,  a  carpenter  shop,  forge,  and  mechanical 
workshops  are  in  course  of  construction.  Already  the  cai-penter's  department 
is  well  developed,  and  is  in  a  position  to  execute  orders  for  open-air  shelters  and 
other  portable  wooden  structures.  This  department  is  managed  by  an  ex- 
patient,  a  skilled  carpenter,  and  is  run  on  business  lines;  the  actual  work  is 
carried  out  entirely  by  the  patients.  The  making  of  parts  for  the  Cambridge 
Scientific  Instrument  Co.   is  another  enterprise  which  has  passed  the  experi- 


34 

lueutal  stage.  CH>portuuity  for  tLe  employmi'Ut  of  some  women  patients;  is  HHip- 
pliiHl  by  a  neifiliboring  fruit  an«l  jam-nuilcinir  industry.  Tlio  pardeus  and  land 
oCfer  au  a;;n"ieultural  training  tu  tiiose  wlio  elect  for  it.  With  a  view  to  tlio 
pej-manent  settlement  of  eJt -patients  tlie  colony  has  acquired  some  model  cottjiges 
formerly  occupii'U  by  employees  on  the  estate;  the  erection  of  further  cottages 
will  be  tlie  work  of  tlie  patients.  Already  applications  by  former  patients  for 
cottages  exceed  the  available  acconnnodation.     (Lancet,  Aug.  3,  1918.^ 


[Literary   I)igi>st :   I>cscrii>tion   of   Knliaiu    I'lace  Colony   for  disablcnl  uien.] 

Vocational  training  for  disabled  men  in  village  centers  is  taken  ui)  by  Ihe 
Red  Cross  of  England,  following  th(>  example  of  France  and  Italy.  In  March 
or  April  the  first  of  these  centers  will  open  at  Enhani  Place,  near  Andover.  A 
grant  of  $.50,000  has  been  made  Ity  the  British  Red  Cross  Society  for  the  building 
i:nd  equipmetit  of  the  medical  block.  Other  agencies  contributing  help  are  tlie 
Ministry  of  I'enslons  and  the  Board  of  Agriculture.  A  center  wliere  1,000  men 
can  be  provided  for  will  involve  an  expenditure  of  !?.'00,000  says  the  Lond(m 
Weekly  Times,  but  existing  huiltlings  are  to  be  found  at  Knliam  where  1.50  men 
can  l>e -started  on  the  wa.v  to  restoration.  The  picture  is  one  to  consider  for  our 
own  disabled  soldiers: 

"  Enhaui  Place  is  a  large,  handsome  hou.se  in  the  middle  of  some  of  the  most 
beautiful  scenery  in  Hampshire.  The  whole  estate  covers  1,027  acres,  and  con- 
tains four  farms,  three  big  houses,  two  .smaller  ones,  a  village  hall,  post  oflic?. 
smithy,  and  over  20  cottages.  The  village  centers  council  chose  it  with  a  view 
not  only  to  what  may  be  called  its  practical  advantages,  but  to  its  suitability 
for  men  with  siiattered  nerves  needing  rest  and  fresh  air. 

"  The  future  occupants  of  the  center  will  be  those  who  are  suffering  from  the 
effects  of  shell  shock,  or  are  crippled  by  wounds,  or  have  lo.st  a  limb,  or  are  r<'- 
covering  from  illness,  or  have  been  recommended  a  country'  life.  It  is  not  pi"o- 
posed  to  receive  men  who  can  not  reasonably  be  expected  to  recover  any  capa<'ity 
for  work.  Some  of  the  new  villagers  will  be  instructed  in  various  branches  of 
farming  and  gardening,  dairy  work,  and  poultry  keeping.  Others  will  l)e  taught 
carpentry,  furniture  and  boot  making,  tailoring,  motor  repairing,  biiilding,  paint- 
ing, and  phimbing.  The  intention  of  the  council  is  to  establish  many  small 
workshops  and  classes  rather  than  a  few  large  ones,  the  aim  being  to  bring  out 
each  man's  individuality  and  provide  opportunity  for  his  tastes.  The  commu- 
nity hopes  to  supply  most  of  its  own  wants  and  to  lay  out  its  own  land.  The 
characteristics  of  tlie  "  institution  "  are  to  be  avoided.  The  men  themselves 
will  have  a  voice  in  the  management  of  the  center,  and  the  real  communal  iden 
will  be  fostered. 

"  It  will  be  gathered  that  the  essence  of  tlie  scheme  is  to  combine  cuiTitive 
treatment  with  vocational  training.  A  man  will  be  put  on  the  road  to  i-ecover;- 
while  he  is  'finding  his  feet'  industrially.  Nor  is  it  intendefl  that  during  thi 
period  the  patient  and  pupil  should  he  segregated  from  his  wife  and  faniil,- , 
if  he  possesses  them.  As  soon  as  funds  allow,  more  cottages  will  be  bui!i. 
.so  that  the  family  man  will  be  able  to  get  a  home  and  a  piece  of  land  on  fair 
terms  during  his  iToare.ss  to  recovery,  which,  in  many  cases,  may  take  a  long 
time. 

*'  So  far  as  his  disability  \\ill  allow,  the  disabled  man  must  be  brought  f'> 
his  full  iK)tentiaI  value  as  a  unit  of  the  Nation."  Such  is  the  ideal  expressed 
by  the  village  centers  council. 


35 

I'l.AN     >'01{     INDUHTIilAr,     VII,l,A(iKS     AS     Ol  '11,1  MJ)     JiV     'IIIOMA,*      II.     MAVVSON      |\      ",\S 

iM  l'i;itlAI,    (ir.l.MIA  IHU'V." 

'riic  vision:  TIio  (]is.'il»i<'<|  soldier  pl.'iciMJ  iiiiioii^  ji l.tractlve  HiirroutHlint^H,  drafted 
into  couyeiiial  uiid  |ti'olil;il^)(r*  fiiiplo.viiKMil,  jukI  contrilmtintc  in  llf  nntional 
v.x'lfare  as  u  useful  cil;iz«n  of  his  coiiiiiiuriit.v. 
Cliaruct(Ti sties  of  tlio  villago*: 
Artistic  ami  j)ractic"al. 
Unity  of  purpose. 

Paranuxiiit  industry,  but  diversity  of  occupations. 
Abundant  lioiisinj;'  facilities  and  vvoi'king  facilities. 
Cottaf;es  j-atlier  tlian  coinniunily  blocks  f)r  flats, 
Cliurcbes  and  ji^ood  sciioois. 
Tlie  inhabitants: 

Any  who  are  below  tlie  normal   in   pliysical   power — not  totally  disabled. 

Some  able-bodied  persons  nuist  be  admitted  for  those  tasks  wbich  i-c(|uire 

the  full  measure  of  physical  and  mental  strength. 
Widows  and  children  of  soldiers. 
The  occupations : 

Varied  to  suit  tlie  mental   capacity  and  different  decrees  of  disu!)ility  of 

those  employed. 
Individualized  handicrafts  to  a  limited  extent  only. 
Centralized    industry    of    some    article    of    commerce    desi.ifned    .mi    sound 

artistic  and  constructive  principles. 
Factory  processes  which  may  be  carried  on  in  the  workers'  lK)mes. 
Factory  work  on  the  usual  scale. 

Small  workshops,  where  processes  are  subdivided  amon^  a  few  people. 
Agriculture  on  a  small  scale,  as  market  gardens,  nurseries,  dairies,  poultry 

raising. 
Buying    and  -  selling    needed    materials,    collecting    and    disiril)uting    the 

products. 
Local  agencies  for  large  mercantile   and   insurance  companies,   railways, 

Government  departments,  as  post  office,  etc. 
(This  last  would  afford  opportunity  for  the  blind  as  telephone  operators  and 

typists. ) 
Requirements  of  the  selected  industry. 
Suitable  to  the  locality. 
Suitable  to  the  disabilities  of  the  men. 

A  great  variety  of  branches  and  possibilities  of  application. 
Opportunities  for  piecework  at  home  as  well  as  factory  proces.ses. 
The  size  of  the  village :  / 

Many  small  villages  have  an  advantage  over  a  few  large  ones. 
About  3,000  people  is  suggested  as  a  proper  niuuber. 
Location  of  the  village : 

Not  too  far  distant  from  former  liomes  of  the  disabled. 

Easily  accessible   for  obtaining   raw  materials,   and   with   easy   nipans   of 

egress  for  the  finished  articles. 
With  good  railroad  connections,  good  main  roads. 
Control  of  the  villages : 

Through  a  central  committee  with  the  assistance  of  district  and  local  com- 
mittees for  each  village.     This  local  comiiiittee  would  act  as  a  public 

utility  committee,  with  a  pa'd  executive. 
Residence  in  the  villages  would  be  purely  voluntary. 


3G 

Control  of  the  villa.ues — Coiitimu'd. 

lU'Utiii};   cottages,   establishing  shops   or  some  business,    taking  up   sninlF 
hi-lilings  or  niarliet  jjarileus,  must  be  done  on  exactly  the  same  terms  as 
in  any  other  town. 
Villagers  would  meet  their  expenses  in  the  !?ame  way  as  in  otlicr  towns, 
the  difTerenee  being  that  necessities,  power,  water,  etc.,  would  be  sup- 
pliiHl  to  them  on  specially  advantageous  terms. 
Care  must  be  taken  of  the  property.    Rents  must  be  paid. 
Types  of  the  villages: 

1.  Suburban  colonies — near  industrial  centers. 

2.  An  old  village  with  an  established  imlnstry  reconstructed. 

3.  A   new   village,   cho.sen   and   planned   on    the   best   lines   fur    its   .special 

adaptability  to  the  purposes. 
Things  to  avoid  in  planning  the  village: 
Anything  artificial  or  superficial. 

A  village  of  institutions  half-hospital  and  half-barracks. 
Anything  which   would  tend  to  the  pauperization  or  exploitation   of   the 
villagers. 
How  to  finance  the  project : 

1.  Financing  the  original  construction : 

(a)   Government  aid. 

(6)    Supplementary  aid  from  philanthropic  sources. 
(c)  Donations  for  memorials  in  various  forms,  as  a  block  of  flat-.,  a 
single  cottage,  a  street,  a  park,  churches,  clubs,  etc. 

2.  Organizing  the  industries  on  a  self-supporting  basis : 

(o)   Government  loans. 

{b)   Semiphilanthropic  loans. 

(c)    Small  investments  from  the  woikmen  themselves. 

3.  The  maintenance  when  established: 

Marketing  the  products. 

Attracting  outside  visitors,   who   will   buy   the   small   articles   of   the 
home  industries. 
Will  it  payt — It  will  restore  the  man  power  of  the  nation  among  those  in 
whom  it  has  been  sadly  reduced. 

It  will  make  a  small,  but  by  no  means  negligible  contribution  to  the  solution 
of  the  financial  problems  of  the  after  care  of  the  disabled  soldier. 

It  will  help  toward  the  payment  of  that  "  debt  of  honor,"  which  we  owe  to 
those  who  have  fought  our  battles  for  us. 


Appendix  II. 


A  Discussion  of  the  Tuberculosis  Community  by  Tuberculosis  Specialists  and 

Tuberculous  I'atients. 

[Report   by    Dr.    l<\    H.    Ilciso   of    tlir;   (li.-«ns;-,i<iii    on    lli.;    j.aijor    "  Hw^'^cniiuf;   a    comblD<-d 
indu.strial  and  ii^;riciil(  iiial   <(Jintniini(y   for  (lie  I  uIi'T'-iiIouh."  J 

The  subject  of  a  tuberculosis  comniuiiily  was  presented  by  Dr.  IT.  A.  Pat- 
tison,  at  the  Sarnnac  Lake  Club,  on  Thursday  night,  April  15,  1019,  in  the 
pn>sence  of  approximately  25  pliysicians  of  Saranac  Lake  and  the  Trudenu 
Sanatorium,  and  a  few  other  interested  persons.  After  Dr.  Pattison's  reading 
of  his  excellent  exposition  of  the  subject,  the  matter  was  discussed  quite  fully 
and  freely,  the  following  comments  and  questions  being  most  frequently  ex- 
pressed : 

Dr.  Lawrason  Brown  and  Dr.  C.  C.  Trembley :  Immediately  after  the  reading 
of  the  paper,  Drs.  Brown  and  Trembley  discussed  the  fact  that  Saranac  Lake 
itself  could  be  considered  as  a  tuberculosis  community,  inasmuch  as  most  of 
the  business  in  Saranac  Lake  is  conducted  by  people  who  have  had  tuberculosis 
and  who  have  remained  in  Saranac  Lake  to  cater  to  the  wants  of  other  patients 
who  make  Saranac  Lake  their  temporary  home.  It  was  also  suggested  by 
Dr.  Brown  that  the  community  idea  would  be  very  good,  inasmuch  as  it  has 
been  the  experience  in  Canada  and  is  beginning  to  be  found  in  the  United 
States!  that  the  Government  is  unable  to  hold  its  tuberculous  soldiers  in  sana- 
toria, especially  if  vocational  employment  was  not  given  the  men,  and  that  the 
community  idea  would  in  all  probability  help  to  solve  the  problem  of  the  after 
care  of  the  soldier  who  has  contracted  tuberculosis  but  who  wishes  to  take  off 
Ills  uniform  and  enter  civil  life  again,  affording  him  excellent  means  of  taking 
care  of  himself  and  at  the  same  time  providing  certain  funds  for  his  main- 
tenance. 

Mr.  Feustman  (of  Scopes  &  Feustman,  architects  in  Saranac  Lake),  ex- 
pressed the  thought  that  the  community  idea  appealed  to  him  as  being  very 
ideal,  and  that  the  community  could  be  made  very  beautiful.  He  saw  no  rea- 
son why  a  community  established  along  such  lines  (as  advanced  by  Dr.  Pattison) 
could  not  be  made  equally  as  successful  as  other  industrial  communities. 

Dr.  Trembley  later  expressed  the  belief  that,  if  life  was  made  livable  and 
there  were  several  varieties  of  occupation  in  the  community,  and  provided  there 
was  a  sufficient  reserve  fund  to  make  up  the  deficiencies  in  earning  power  of 
those  able  to  work  only  part  time  so  that  they  could  live  comfortably,  the  plan 
ought  to  work  out  quite  well.  Dr.  Trembley  divided  the  patients  in  Saranac 
Lake  into  three  types:  (1)  Those  who  eventually  will  be  able  to  go  back 
and  resume  work  of  a  certain  amount  and  character,  (2)  those  who  have  a 
hope  of  returning  after  a  period  of  time  more  or  less  indefinite,  and  (3)  those 
who  have  no  hope  of  being  able  to  work  again. 

Mr.  R.  M.  Obenchain,  executive  secretary  of  the  Saranac  Lake.  Society  for 
the  Control  of  Tuberculosis,  and  bureau  of  information,  etc.,  stated  that  in 
his  belief,  inasmuch  as  the  care  of  the  health  of  the  patients  of  the  community 
would  be  an  essential  factor,  patients  would  therefore  be  attracted  by  it  and 
would  be  anxious  to  go  there  if  able  to  work. 

(37) 


38 

Dr.  Ili-itwu  exproesetl  the  belief  that  Saraimc  Lake  wouUl  not  be  a  very  choice 
location  for  a  tuberculosis  colony,  because  it  is  nol  situated  on  the  main  line  of 
any  railroail  and  is  not  wilbin  very  short  haulinj:  distance  of  areas  of  produc- 
tion of  jrood  at:ri«-ultural  crops  and  food.  lie  thofi;;iit  the  colony  sliould  bi> 
estaltlisiu'd  on  a  main  line,  in  a  re^rion  where  tlie  climatic  conditions  are  favt)r- 
able  »Mu>n:.'b  to  j;ro\v  a  variety  of  crop.s.  He  tliouKlit  Saranac  LaUe  and  similar 
places  could  be  used  h8  preparatory  places  for  patients  to  qualify  for  entrance 
later  to  the  commuinty. 

Dr.  R.  C.  Patterson  (of  Saranac  Lake)  advanced  two  tiieorctical  objections, 
ns  he  ternie<l  them;  (1)  that  he  questioned  whether  or  not  the  marketing  of 
articles  made  by  the  tiiberculous  would  be  an  easy  matter,  (2)  he  luentioneil 
the  possible  ohje<'tion  of  the  labor  \inions  to  any  such  plan. 

Dr.  Brown  incidentally  mentioned  that,  at  base  hospital  No.  16,  New  Haven. 
Conn.,  where  there  is  vocational  training  for  the  tuberculous  .soldiers,  enouicli 
iroods  can  not  be  proiluce<l  to  meet  the  public  demand. 

Dr.  H.  A.  Bray  (resilient  iibysiclan,  Ray  Brook  Sanatorium)  advancctl  liis 
opinion  tbat  the  sanatoria  tlieni.selves  would  offer  a  jrood  ti*'ld  for  markctiii;; 
the  produ<-ts  of  the  connnunity  iiahistry  or  induslrins,  such  as  books,  ]irintlMt,', 
pottery,  dishes,  .spvitum  cups,  and  thinj^s  of  like  nature. 

Dr.  U,  C.  Patterson  advanced  his  belief  that  the  various  beneficial  imlons, 
labor  unions,  and  other  beneficial  societies,  would  be  relieve<l  of  a  great  deal  of 
the  burden  of  benefit  payments,  insurances,  etc.,  on  account  of  the  patient's 
being  able  to  take  up  remunerative  employment  at  a  time  when  he  wouUl  not 
be  able  to  return  to  his  home  and  do  a  full  day's  work. 

Jlr.  Obenchain  then  questioned  what  could  be  dime  with  the  arreste<l  case 
who  came  to  the  colony  for  employment  and  later  became  active,  especially  if 
he  were  not  a  re-sldent  of  the  State  in  which  the  colony  was  locattn;!. 

Dr.  Brown  asked  how  cases  would  be  selected  for  eligibility  to  the  colony, 
what,  if  any,  centers  would  be  established  as  clearing  houses,  and  what  men's 
opinions  ought  to  be  accepted  for  eligibility,  expressin:,'  his  own  belief  that  a 
medical  man  should  pass  upon  eligibility. 

Dr.  R.  C.  Patterson  asked  what  would  become  of  tiie  patient  who  had  worketl 
for  a  year  and  then  became  totally  unfit  for  work.  Would  hp  boiome  a  com- 
munity charge,  and  woulil  the  cmnmunity  support  him? 

Dr.  Bray  asked  whether  or  not  the  colony  was  for  soidifM's  and  sailors  alone, 
and  expressed  the  opinion  that  there  should  be  an  understanding  that  the 
colony  would  retain  the  privilege  of  sending  back  any  case  accepted  for  em- 
ployment, provided  such  a  course  was  seen  fit.  He  also  expressed  the  opinion 
that  perhaps  the  tuberculosis  case  does  not  wish  to  be  segregated. 

(The  consensus  of  opinion  of  those  present,  however,  seemed  to  be  that  this 
difficulty  would  be  almost  negligible.) 

Dr.  Patterson  suggested  the  addition  of  rcforestration,  that  i.s,  the  growing 
of  seedlings  for  transplantation,  to  the  intorosts  of  Iho  colony,  nnd  Dr.  Brown 
suggested  the  addition  of  forestry  work. 

Then,  inasmuch  as  it  was  the  consensus  of  oi)inion  that  a  large  endowment 
would  be  necessary  to  make  good  the  deficiency  in  the  earning  power  of  the 
patients,  Dr.  Brown  questioned  where  the  endowment  would  come  from,  whether 
from  tlie  Red  Cross  or  .some  such  foundation  as  the  Rockefeller  Foundation, 
etc.,  and  gave  it  as  his  opinion  that  tJie  R»^l  Cro.ss  wouhl  probably  be  the  best 
agency  to  do  the  work. 

*  *  *  ^t  #  i^  * 

Through  the  courtesy  of  Dr.  F.  H.  Hei.se  the  colony  idea  was  explained  to 
the  as.sembled  patients  of  Trudeau  Sanatorium  for  the  purpose  of  learning  what 


39 

response  luiiL;! it  ho  (;xpof;tx)(l.  ii'om  jjaticiii.H  LlioinscWvo.s  U)  llu;  ojiportuiiitics 
offered  in  suf:h  a  eornrauiiity.  The  following  day  t,h(>  project  was  also  explained 
to  groups  of  pfitients  at  Ilay  Broolt,  the  New  Yorit  State  Sanatorium. 

]\lis.s  J.  S.  W]»il;ney  has  made  the  following  report  of  tlie  diHcuHsion  and  of 
int(>fviews  witli  j)atienl,H: 

The  lirwt  question  raised  was  wIicjIlHjr  tlie  products  of  a  factory  in  such  a 
coiiununily  would  ho  irairketahle.  'i''liis  brought  out  consid(!ral)le  discussion,  tht; 
gist  or  wlucli  was  tluit  it  depinuhNl  on  tlie  kind  of  produ<.'t. 

One  patient  suggested  that,  since  the  aiTcsted  cases  of  tubercialosis  are  not  able 
to  work  full  time,  a'  seven-hour  day  should  be  inauguratCMl,  thus  giving  three; 
and  a  half  hours  work  in  the  morning  and  three  and  a  half  in  the  afternoon. 

A  particular  point  was  in  regard  to  the  class  of  people  who  could  be  induced 
to  come  to  such  a  community.  One  pntient  said  "  that  it  was  very  well  for  labor-v 
ing  men,  but  where  would  the  man  who  was  making  $60  or  $80  a  week  find  em- 
ployment in  such  a  community?" 

Another  suggestion  made  was  that  they  would  be  branded  as  tuberculous 
patients  if  they  went  into  a  community  where  practically  only  the  tuberculous 
were  admitted.  The  consensus  of  opinion,  however,  was  that  it  would  be  a 
great  advantage  in  the  first  few  months  after  leaving  the  sanatorium  to  be 
in  a  place  where  there  were  ex-patients.  They  felt  that  there  would  l>e  the 
same  incentive  and  inspiration  in  a  community  of  that  sort  that  there  is  at 
Trudeau  at  present.  If  they  returned  to  tlieir  own  homes  they  would  lie 
branded  and  shunned. 

A  young  Jew,  who  was  married  and  bad  one  child,  had  been  a  bookkeeper. 
His  home  had  always  been  in  Brooklyn.  He  said,  "  You  can  count  on  me  and 
also  my  wife  as  being  very  glad  to  leave  the  city  and  go  to  a  country  commu- 
nity." They  had  always  wanted  to  do  it  but  had  never  been  able  to  go  anywhere 
in  the  country  where  he  could  find  employment. 

Later  when  the  formal  discussion  had  closed  and  most  of  the  patients  had 
left,  several  remained  to  get  more  information  about  certain  points.  One 
young  woman  came  up  to  us  and  said  she  wished  to  be  enrolled  now,  as  the 
first  citizen  of  that  community.  Tlie  idea  seemed  to  be  accepted  with  enthu- 
siasm, and  it  was  a  surprise  to  Dr.  Heise,  Dr.  Pattison,  and  myself  to  see  how 
immediate  and  spontaneous  the  favorable  reaction  was.  It  almost  put  upon  us 
an  obligation  to  make  the  idea  a  reality. 

About  30  patients  handed  in  their  names  to  me  as  interested  in  the  project. 
I  saw  a  great  many  of  them  that  evening  by  themselves  and  talked  with  them 
separately  about  it. 

One  young  Virginian  who  bad  spent  10  months  overseas,  bad  been  gassed,  and 
attributed  his  tuberculosis  to  this,  said  be  would  like  to  go  to  such  a  community 
and  grow  up  with  it  and  do  what  he  could  to  favor  its  development.  Prior 
to  going  overseas  he  had  been  a  timekeeper  in  a  big  munition  factory,  making 
$75  per  month. 

A  minister  who  had  been  a  missionary  in  China  would  be  glad  to  move  to 
such  a  community  at  once.  He  is  a  widower  and  has  four  children.  He  felt 
that  it  would  be  the  best  place  for  him  and  also  for  his  children.  He  said 
that  if  there  was  no  opportunity  in  the  beginning  for  him  to  practice  his  own 
profession,  be  would  be  glad  to  go  there  and  help  in  any  possible  way  the  de- 
velopment of  such  a  plan. 

A  young  doctor,  who  is  now  classed  as  an  ex-patient,  was  very  enthusiastic 
about  the  plan,  and  although  he  said  he  might  not  go  there,  as  he  had  his  future 
plans  well  arranged,  he  felt  that  for  most  of  the  patients  at  Trudeau  it  would 
be  a  great  boon. 


40 

A  Vdunfr  couplo,  l>oth  ox-pat ii'iits,  who  expect  to  marry  soon,  came  in  tcv 
gether  to  talk  to  nie.  To  both  of  them  it  seemed  an  ideal  arraiij^emeut  in  their 
case,  and  both  of  them  exjiressed  themselves  as  williii!;  to  ko  immediately  to 
such  n  colony  were  it  already  establisht'd.  Their  ea;:erness  was  pathetic.  Bodi 
will  have  to  leave  Trudeau  soon  and  neitlier  has  any  delinite  plans.  The  {iirl 
said  that  she  did  not  want  to  po  liome  because  she  felt  sure  that  not  only  her 
friends  but  Iter  family  would  consitler  her  almost  a  leper. 

This  couple  raised  the  question  of  whether  any  cottages  would  be  furnished 
or  not.  They  seemed  to  think  that  it  would  be  a  very  good  idea  if  some  fur- 
nished cottages  could  be  rented,  and  tliat  after  a  certain  amount  had  been  paid, 
the  furiuture  would  becDUie  tlie  prtiperty  of  the  renter. 

Dr.  I'attison,  in  company  willi  Mr.  OI)eiuliain,  of  the  bureau  of  Information  at 
Saranac,  interviewed  several  residents  of  the  town.  One  man  was  a  Jew  aged 
3G.  He  is  a  furrier  with  a  wife  and  four  children,  lie  had  migrated  from 
Russia  to  New  York  City  and  had  lived  there  two  years  before  coming  to 
Saranac.  lie  had  been  in  business  at  Saranac  for  15  years.  His  opinion  was 
that  if  a  place  was  a  healthful  locality  for  the  tuberculous,  it  must  be  a  health- 
ful place  for  well  people  to  live  in  because  greater  precautions  were  taken  there 
against  infection.  He  ami  his  family  have  kei)t  well;  he  has  made  money; 
owns  his  own  home,  and  has  just  bought  a  new  car. 

Another  Jew,  who  is  a  second-hand  clothes  man,  has  been  living  in  Saranac 
for  several  years.  He  had  previously  lived  for  four  or  five  years  in  one  of  the 
cities  of  New  York  State.  Ho  thinks  he  has  a  good  opportunity  in  business  at 
Saranac,  and  says  he  makes  a  fair  living  for  his  family. 

Another  Jew,  aged  37  and  single,  came  from  Syracuse  to  Saranac  14  years 
ago.  »He  .says  he  makes  as  much  or  more  here  than  he  did  in  Syracuse,  and 
would  not  want  to  go  back  to  the  city. 

Still  another  Jew,  who  came  here  from  New  York  City  and  has  lived  in 
Saranac  for  four  years,  says  he  would  be  the  first  applicant  for  a  job  in  sucli 
an  industrial  commuuity.  He  was  formerly  in  charge  of  the  upkeep  of  ma- 
chines in  a  glove  factory  at  $35  a  week.  He  is  now  doing  odd  jolis  of  repairing, 
such  as  sewing  machines,  etc.  He  does  not  make  much  here  because  there  is 
so  little  call  for  his  kind  of  work. 

At  Hay  Brook  I  found  the  same  eagerness  in  regard  to  the  idea.  Many  of  the 
younger  girls  said  that  they  w(>re  quite  .sure  their  families  would  move  to  such 
a  comnumity  if  it  meant  an  improvement  in  the  girl's  healtli  or  would  be  an 
advantage  to  her  in  any  way. 

Among  the  married  women  there  were  several  whose  children,  sometimes  two, 
three,  four,  or  five  in  the  family,  were  in  orphan's  homes,  while  the  mother  was 
at  the  sanatorium.  One  womau  said  her  husband  had  also  bad  tuberculosis 
and  he  was  not  able  to  do  steady  work.  A  home  for  them  in  such  a  community 
wouhl  mean  a  great  deal. 

Two  Italian  women,  one  of  whom  spoke  very  little  English,  were  most  en- 
thusiastic about  the  idea.  They  had  both  worked  in  factories  prior  to  going 
to  the  sanatorium  and  would  be  L'^lad  (jf  an  opportunity  to  <lo  any  kiinl  of  factory 
work. 


[Extracts  from  a  group  of  lottcrs  written  liy  tubiTculous  patients  to  the  S'ntlonnl  Tul)er- 
culosis  Association  concerning  the  proposition  of  a  tuberculosis  community.] 

I  most  heartily  indorse  the  scheme  you  proposed  to-day.  Such  a  comimmity 
would  supply  the  logical  stepping  stone  to  "  full-time "  work,  without  which 
we  must  acknowledge  our  physical  unfitness  or  our  being  tuberculous  when 
applying  for  work.    Either  one  of  these  is  going  to  make  our  return  to  a  useful 


41 

life  infinitely  moi-e  difriciiK;.  I  iiiii  iiboiil  1,o  l(!iivo  tlio  sanatoi'Iiiiii,  and  a  r-om- 
miinit.y  of  this  sort,  would  Holvo  my  \)\'^  jtrohlorn.  I  know  tiio  sifiialion  thai  1h 
confroritin;,'  Jiio  now,  hcK-uuso  I  was  ciir-cd  once  ijcforc.      (A   yoimt?  woman.) 


I  tliink  it  an  excellent  jiian  to  ronii  a  villa;^o  whore  tubereulou.s  pcoiile  fan 
live  and  find  work.  For  more  than  two  years  I  liave  been  working  four  hours 
a  (lay  in  the  sanatorium  at  Trudeau.  Could  I  find  work  in  a  community  sik-Ji 
as  you  propose,  my  mother  could  be  witli  me  and  I  could  have  8f>mc  home  life. 
(A  younj?  woman.) 


Personally  I  sliould  be  delighted  to  be  among  those  privileged  to  enjoy  the 
advantages  to  be  had  by  an  arrested  tubercular  patient  of  a  few  years  spent 
in  a  tuberculosis  community  such  as  described  by  Dr.  Pattison  to-day  in  JiLs 
talk  to  the  Trudeau  patients. 

It  seems  to  me  that  such  an  arrangement  and  such  safeguarding  of  one's 
healtli  by  life  in  such  a  place  is  the  only  really  sensible  course  to  be  considered 
by  any  arrested  tuberculosis  patient  who  realizes  the  seriousness  and  insidious- 
noss  of  tuberculosis.     (A  j'oung  woman.) 


It  is  tlio  most  practical  plan  of  help  without  pauperizing  that  has  ever  come 
to  my  notice  and  I  would  consider  it  a  privilege  to  be  associated  with  any  such 
undertaking.      (A  young  woman.) 


From  personal  feeling  and  conversation  with  others  I  am  thoroughly  con- 
vinced that  the  establishment  of  a  community  where  tubercular  patients  un- 
able to  work  full  time  could  find  limited  work  under  good  living  conditions 
would  be  a  boon  very  greatly  appreciated  and  that  no  difhculty  would  be  found 
in  filling  such  a  community  to  its  full  capacity.      (A  young  man.) 


Your  talk  of  this  afternoon  in  regard  to  the  community  you  are  planning  for 
arrested  cases  of  tuberculosis  has  made  a  deep  impression  upon  me,  and  I 
must  say  that  the  majority  with  whom  I  have  spoken  on  the  subject  agree 
that  the  project  is  highly  feasible. 

When  we  consider  the  number  of  affected  people  who  leave  the  cities  and 
strike  out  for  the  open,  whether  it  be  the  West  or  some  place  in  the  mountains, 
to  spend  the  rest  of  their  lives,  where  the  opportunities  are  not  to  be  com- 
pared, nor  so  well  adapted  to  their  condition  as  those  you  propose,  I  believe 
there  will  be  little  or  no  difiiculty  in  getting  all  the  people  you  wish  to  go 
to  the  town  under  consideration. 

There  would  be  some  who  would  hesitate  to  bring  their  families  to  such  a 
community  because  of  a  fear  of  exposing  them  to  tuberculosis,  but  I  believe 
that  the  statistics  from  such  places  as  Saranac,  w^hich  show  that  the  tuber- 
cular mortality  among  the  native  population  is  lower  than  the  average,  would 
soon  set  such  fears  at  rest. 

Your  project,  I  believe,  will  be  a  boon  to  the  tubercular,  not  only,  but  a 
welcome  relief  to  physicians  of  sanatoria,  who  if  advised  of  the  work  and 
kept  advised  of  the  progress  of  the  town,  would  send  plenty  of  arrested  cases 
there,  many  of  whom,  I  believe,  would  become  permanent  residents. 

I,  for  one,  would  be  glad  to  cast  my  lot  in  such  a  town,  and  wish  you  every 
success  that  the  project  may  become  a  reality.      (A  young  maii. ) 


42 

I  was  deeply  iinpressoil  wilh  tlu'  i<lr:i  as  expressed  by  Dr.  raltisuii  to-day 
in  repird  to  iunu^jurathi^  a  tuberculosia  ooiiiiminity.  It  appeals  to  lue  as 
belug  very  logical  for  this  reason,  besides  which  there  iire  many  others  in 
Its  favor.  From  my  own  case — when  I  lejive  this  place  I  will  be  without  a 
position  at  which  I  will  be  able  to  make  a  living  equal  to  that  which  I  made 
when  tflken  sick.  I  live  iu  U»e  city  of  New  York,  wiilch  place  can  not  alTord 
the  beneiit  of  outdoor  sleeping,  much  less  the  pure,  cloflii  air  of  Odd's  own 
creation,  (he  country.  Th«>re  are  many  wl»o  would  not  be  satislie<l  to  leave 
the  gay  wlute  way,  not  even  for  tlie  l)enelit  of  llieir  hejilth,  but  you  can  count 
my  family  and  myself  as  on»»  wlio  would  gladly  acceiit  tlie  opportunity  to  l)e 
a  i)ioneer  family  in  such  a  community.      (A  mairied  man.) 


This  seems  to  nie  to  be  the  most  encouraging  thing  I  have  ever  heard  of 
for  tubercular  patients.  I  for  one  am  certainly  heartily  in  favor  of  such 
a  move. 

I  venture  to  say  that  the  large.st  per  cent  of  patients  feel  as  I  do  about 
the  euterprise.  I  have  been  told  tliat  I  can  go  back  and  do  a  full  day's 
work  anywhere  I  want  to,  but  I  am  afraid  to  take  the  chance  of  living  again 
Avith  well  people  and  doing  as  I  know  I  would  have  to  do.  So  I  am  leaving 
this  week  for  Denver  and  will  try  to  get  into  some  business  out  there  for 
myself  whereby  I  can  comfortably  support  myself. 

I  have  been  for  more  than  a  year  the  bookkeeper  for  the  above  sanatorium, 
but  feel  that  it  is  up  to  me  to  get  out  into  the  world  and  make  the  l)est  living 
that  I  can.  Tlie  chanci's  are  that  if  it  is  found  out  that  I  am  a  lunger 
my  chances  for  good  positions  will  be  greatly  dinnnisiied  with  business  lirms. 
(A  young  man.) 


At  present  I  personally  wish  llierc  were  just  such  a  place  that  I  might 
turn  to,  for,  although  the  doctor  has  recomnu<fided  that  I  return  to  my 
former  position  as  a  school-teacher,  I  should  prefer  to  forego  home  life  and 
a  high  salary  iu  order  to  insure  future  good  health.     (A  young  woman.) 


I  think  that  the  plan  you  have  worked  out  for  the  solution  of  the  post 
sanatorium  treatment  of  tuberculosis  so  transcends  in  importance  any  con- 
sideration of  cost  that  you  ought  to  proceed  absolutely  regardless  of  cost 
factors.  I  really  believe  that  some  such  .scheme  as  you  have  outlined  is  the 
only  .solution  of  the  problem.  After  all,  what  you  propose  is  not  revolutionary, 
merely  a  step  or  two  further  than  the  many  housing  projects  which  have 
been  launched  in  this  country  and  in  England.  (An  architect  who  himself 
bas  had  tuberculosis.) 


Appendix  III. 


AN  INVESTIGATION  OF  THE  PROBABLE  MAXIMUM  AMOUNT  RE- 
QUIRED  AS  SUBSISTENCE  AID  DURING  ONE  YEAR  FOR  A  GIVEN 
NUMBER   OF   TUBERCULOUS   PERSONS    AND   THEIR    FAMILIES. 

[Study  mndo  Ivy  MIhs  J.  S.  Wliitiipy,  Rcscni-fli  Snrrcfiiry  National  'J'iif>er<:uloHi!*  AMHOciatlon.] 
In  se(.'urin.i;  dalu  tlio  I'ollowiny,  sclu'cJulc  was  iiswl : 


1.  Sanatorium 2.  Date 

3.  Patient 4.  Age i 

5.  S(>x_' 6.  Marital  state 

7.  Main  occupation 8.  Olhor  occupations. 

9.  Faniilv  outline: 


Sex. 

Age. 

Occupation. 

Normal  weekly 
earning:g. 

Weekly  earnings 

since  patient's 

illuesa. 

Total 

Minimum  amount  to  be  furnished  by  family  in  col 
normial  weekly  earninejs,  less  onfi-ha.lf  natieTir'n  < 

ony  (based  upon 
3arnings) 

Total  weekly  budget  at" the  mii 
studios  of  Bureau  of  Labor  Stati 
of  Boston,  and  othfr  ovonnizati 

limum  comfort  le 
sties,  Industrial  C 
ons) 

vel  (based  upon 
onference  Board 

Amount  of  help  n 

eeded  weeidy. 

SITMMAEY   OF    SCHEDULES   OBTAINED. 

Numher  of  schedules. — One  hundred  and  eleven  schedules  wei*e  secured  at 
two  sanatoria ;  56  were  for  men  and  55  for  women. 

Of  the  total  number  of  schedules  54  were  for  single  men  and  women,  or 
widows  without  family;  10  schedules  were  for  single  men  and  women  whose 
immediate  families  might  make  a  home  with  the  son  or  daughter ;  and  47 
schedules  were  for  married  men  and  women,  making  a  total  of  57  which  may  be 
designated  as  the  "  family  group." 

Nnmbcr  of  individuaJs. — In  all  there  were  253  individuals  represented,  includ- 
ing children  and  dependent  relatives.  On  the  57  family  schedules  alone  were  in- 
eluded  199  individuals,  or  an  average  of  3.5  persons  to  each  family. 

Average  age. — The  average  age  of  the  patients  in  the  married  gi'oup  was 
slightly  over  30  years,  and  for  the  single  group  25  year«. 

(43) 


4-i 

Theoretical  hmUjet. — A  biulfiot  cif  $1,500  a  j  ear,  which  is  i\  uiiniiuuiu  l)Ud.wt  fur 
a  fiimily  of  five,  was  adopted.  This  is  fur  a  family  of  hiisl)and,  wife,  and  three 
children  under  14,  making  3.3  units,  the  children  being  considered  as  part  units 
according  to  their  subsistence  cost  as  compared  with  that  of  a  worliing  man. 
This  means  a  weelciy  budget  of  .$28.85  for  a  family  of  five.  On  this  basi.s  the 
budgets  for  the  vari(»us  families  were  made  up.  If  the  family  was  larger  than 
live,  the  proportionate  parts  of  a  unit  were  adiled  atconling  to  the  age  of  the 
extra  members  of  tlie  family.  When  there  were  less  than  live  in  the  family  the 
proportionate  amount  was  deducted. 

I'loporiion  needing  astfiatancc  in  fiunily  (/roup. — On  the  basis  of  weelily  needs 
outlined  above,  25  of  the  families  were  found  to  be  able  to  meet  their  own  cost 
of  living,  so  that  no  maintenance  would  have  to  be  supplied  by  the  community. 
(The  wages  used  in  this  compilation  were  in  every  case  those  which  the  patient 
or  men)bers  of  his  family  were  receiving  just  before  the  illness  began.)  Many 
of  these  25  families  are,  of  course,  those  in  whicli  the  wife  was  the  patient  and 
the  normal  earning  capacity  of  the  husband  was  unimpaired.  In  32  families 
the  total  earning  capacity  of  the  family  would  not  meet  its  required  budget. 
Fifty-six  per  cent,  then,  of  the  families  scheduled  would  need  assistance  from 
the  coninninity. 

Amount  of  maintenunce  needed  in  family  group. — The  total  weekly  budgets 
for  the.se  32  families  amounted  to  $752.78.  The  total  amount  of  financial  assist- 
ance needed  weekly  by  them  from  the  community  was  $274.06,  or  3G}  per  cent 
of  their  total  cost  of  living. 

Total  iiccirUj  cost  of  maintenance  in  family  group. — On  the  basis  of  something 
over  100  families  who  would  be  the  pioneer  members  of  the  community,  there 
would  be  practically  twice  as  many  as  have  been  scheduled.  The  maintenance 
fund  shown  above  would  then  have  to  be  doubled,  making  $548  weekly.  This 
would  amount  in  a  year  to  $28,496. 

Proportion  needing  assistance  in  single  group. — In  the  case  of  single  men  and 
women  an  arbitrary  budget  of  $16  a  week  was  established.  There  w-eie  only 
seven  in  the  single  group  who  would  not  need  assistance.  In  this  numljer  are 
included  several  women  who  were  waitresses,  or  in  domestic  service,  and  who 
might  earn  a  living  in  the  employer's  family  even  working  on  a  part-time  basis. 
Forty-seven,  or  S7  per  cent,  would  need  financial  assistance. 

Amount  of  maintenanee  needed  in  single  group. — The  weekly  needs  of  the  47 
would  amount  to  $752  and  the  assistance  needed  to  complete  their  necess;iry 
budgets  would  total  $265,  which  is  35  per  cent  of  the  necessary  cost  of  living. 

Total  yearly  cost  of  maintenance  in  single  group. — If  this  group  scheduled 
were  doubled  in  the  community,  the  weekly  amount  required  would  be  $530, 
which  in  a  year  would  total  $27,500. 

SUMMARY. 

Single  men  and  women  and  family  groups  would  enter  about  evenly  into  the 
community.  Eighty-seven  per  cent  of  the  former  and  50  per  cent  of  tiie  latter 
group  would  need  financial  help  from  the  community  to  assist  in  their  mainte- 
nance. The  amount  required  in  the  single  group  would  be  about  35  per  cent 
of  the  total  budget  and  for  the  family  group  about  36i  per  cent.  The  total 
amount  required  for  both  groups  for  a  year  would  be  $56,056.  This  amount 
represents  the  maximum  need  since  the  time  covered  is  an  entire  year.  IDxperi- 
ence  in  the  Jewish  garment  shop  shows  that  patients  can  resume  more  than 
half-time  work  within  12  month.s.  As  they  are  able  to  increase  their  earning 
capacity  the  supplementary  amount  required  decreases  correspondingly. 


45 


The  followinf,''  arc  the  nialn  occiii)Mtii 
Cloncul  and  odico  work: 

Clerks 10 

Stenographers  9 

Draftsmjiu   I 

ISookkeepers 7 

I 'roIVssional ; 

(Jriiduate   uurse 1 

]\Iiiiis(or    1 

Physician   1 

TtNicliers 3 

School   principal 1 

Illustrator   1 

Trade  and  transportation : 

Salesmen 4 

Saleswoman 1 

Railroad    brakeman 1 

Ilailroad   engineer 1 

Motor  engineers '2 

Chauffeur 1 

Motorman 1 

Telephone  operators 3 

Domestic  and  personal  service : 

Children's  nurses 3 

Waitress 1 

Dressmaker  1 

Housewives , 18 


ons  of  llif!  p;iti(>ntH  Kf'h<!du!ed ; 
i'\'i/"tory  or)er!iLlvoH : 

(;!l()ve . 1 

Kin'Lting    2 

Woolen  clothing 4 


Collar 

Shoe 

Steel  

Neckwear 

Ammunition  _, 
Miscellaneous 
Skilled  trades: 
Electrician 


Carpenter  1 

Machinists  

Toolmaker    

Pattern   maker 

Riveter   

Millwright's  helper 

Retoucher 


0 

1 

1 

1 

1 

1 

Pipe    fitter 1 

Stove   mounter 1 

Printing  and  publishing: 

Pressmen   2 

Folder  1 

Printer 1 

Lithographer 1 

Government  service : 

Army 1 


46 

PUBLICATIONS  OF  THE  VEDKKAL  BOARD  FOR  VOCATIONAL 

EDUCATION. 

Th©  Vocational  Summftry,  published  monthly  by  the  Federal  Board  for  Vocational  Educa- 
tion  (vol.   1.   No.   1.   May.   1918). 

Bulletin   No.    1.   Statement  of  Policiea. 
'Bulletin  No.  2.  Training  Conscripted  Men  for  Service  as  Badio  and  Buzzer  Operators  in  the 
United   States  Army    (Inttirnutional  Code). 

Bulletin   No.   3.   Emergrenoy  Training:  In   Shipbuilding — Evening  and  Part-Time   Classes   for 
Shipyard   Workers. 
•Bulletin    No.    4.  Mechanical    and    Technical   Training    for    Conscripted    Men    (Air    Division, 
U.   S.   Signal   Corps). 

Bulletin   No.    5.    (Reeducation   Series   No.    1.)     Vocational   Kehabilitation   of   Bisabled   Sol- 
diers and  Sailors.      (Also  printed   as   S.   D«c.    166.) 

Bulletin    No.    6.    (Reeducation    Series    No.    2.)       Training    of    Teachers    for    Occupational 
Therapy   for   the  Rehabilitation   of   Disabled  Soldiers   and   Sailors.      (Also  printed  as   S. 
Doc.    167.) 
•Bulletin  No.  7.  Emergency  War  Training  for  Motor-Truck  Drivers  and  Chauffeurs. 
•Bulletin    No.    8.   Emergency  War  Training   for  Machine-Shop   Occupations,    Blacksmlthlng, 

Sheet-Metal  Working,   and  Pipe  Fitting. 
•Bulletin  No.  9.  Emergency  V/ar  Training  for  Electricians,  Telephone  Repairmen,  Linemen. 

and  Cable  Splicers. 
•Bulletin  No.  10.  Emergency  War  Training  for  Gas-£ngine,  Motor-Oar,  and  Motorcycle  Re- 
pairmen. 
•Bulletin  No.  11.  Emergency  War  Training  for  Oxy-Acetylene  Welders. 

•Bulletin  No.  12.  Emergency    War    Training   for   Airplane    Mechanics — Engine    Bepainnen, 
Woodworkers.  Riggers,  and  Sheet  Metal  Workers. 

Bulletin  No.  13.  (Agricultural   Series  No.    1.)     Agricultural   Education — Organization   and 
Administration. 

Bulletin  No.  14.   (Agricultural  Series  No,  2.)     Reference  Material  for  Vocational  AgrlcuU 
tural   Instruction. 

Bulletin  No.  15.   (Reeducation  Series  No.  3.)     The  Evolution  of  National  Systems  of  Voca- 
tional Reeducation  for  Disabled  Soldiers  and  Sailors. 
•Bulletin  No.  16.  Emergency  War  Training  for  Radio  Mechanics  and  Radio  Operators. 

Bulletin  No.   17.    (Trade  and  Industrial  Series  No.   1.)     Trade  and  Industrial  Education- 
Organization  and   Administration. 

Bulletin  No.  18,    (Trade  and  Industrial  Series  No,  2.)     Evening  Industrial  Schools, 

Bulletin   No.    19,    (Trade  and   Industrial   Series  No.   3.)     Part-Time   Trade   and   Industrial 
Education, 

Bulletin  No.  20.   (Trade  and  Industrial  Series  No.  4.)     Buildings  and  Equipment  for  Schools 
and   Classes  in   Trade  and  Industrial   Subjects. 

Bulletin  No.  21.    (Agricultural  Series  No.  3.)     The  Home  Project  as  a  Phase  of  Vocational 
Agricultural   Eduation. 

Bulletin  No.  22.    (Commercial  Education  Series  No.   1.)     Retail  Selling. 

Bulletin  No.  23.    (Home  Economics  Series  No.  1.)      Clothing  for  the  Family. 

Bulletin  No,  24,   (Commercial  Education  Series  No,  4,)     Vocational  Education  for  Foreign 
Trade  and   Shipping. 

Bulletin  No.  25.   (Reeducation  Series  No.  4.)     Ward  Occupations. 

Bulletin  No.  26.   (Agricultural  Series  No.  4.)     Agricultural  Education — Some  Problems  in 
State   Suprvision. 

Bulletin  No.    27.   (Agricultural   Series   No,    5.)     The   Training   of   Teachers   of   Vocational 
Agriculture. 

Bulletin  No.  28.    (Home  Economics  Series  No,  2,)     Home  Economics  Education — Organiza- 
tion and  Administration, 

Bulletin  No.  29.    (Reeducation  Series  No,  5.)     Treatment  and  Training  for  the  Tuberculous, 

Bulletin  No.  30.   (Trade  and  Industrial  Series  No,  5.)     Evening  and  Part-Time  Schools  in 
the  Textile  Industry  of  the   Southern   States, 

Bulletin  No.  31.    (Trade  and  Industrial  Series  No,   C.)     Training  in  Safety  and  Hygiene  in 
the   Building  Trades. 

Bulletin  No.  32.   (Reeducation  Series  No,  6,)     The  Agricultural  and  Industrial  Community 
for  Arrested   Cases  of  Tuberculosis  and  Their  Families, 

All  communications  should  be  addressed  to 

The  Federal  Board  for  Vocational  Edncation,  Washington,  D.  C. 

•  Emergency  war  training  for  conscripted  and  enlisted  men. 


Any  undertaking  hoteeter  Worthy  must  he  preceded  by  dreams. 

We  must  have  first  the  men  who  dream  dreams  and  see  visions. 

Afterwards  we  are  ready  for  those  who  can,  if  they  will,  convert 

the  beautiful  conceptions  into  technical  perfection  so  that  there 

arises  an  equally  beautiful  result. 

— Towner. 
■j!r    -iV    tV 

Dreams  grow  holy  put  into  action;  worl^  grows  fair  through 

starry  dreaming. 

But  where  each  flows  on  unmingling,  both  are  fruitless  and 

in  Vain, 

— Proctor. 

o 


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